An alternative to UnitedHealthcare's imminent gastroenterology endoscopy prior authorization policy was rejected by representatives from three GI societies, who said that they were "not in a position to appropriately evaluate the UHC proposal with the limited information presented."
Representatives from the payer and the American College of Gastroenterology, American Gastroenterological Association and American Society for Gastrointestinal Endoscopy met May 26 to discuss the proposed alternative, according to a May 26 American Gastroenterological Association news release.
UnitedHealthcare proposed delaying their GI prior authorization program in exchange for an advance notification program that would require GI practices and staff to gather detailed patient data prior to procedures and in preparation for a UnitedHealthcare gold-card program in 2024, according to the release.
UnitedHealthcare's new prior authorization policy is set to begin June 1. Under the program, prior authorization will be needed for esophagogastroduodenoscopies, capsule endoscopies, diagnostic colonoscopies and surveillance colonoscopies.
The American Gastroenterological Association said in the release that what UnitedHealthcare presented was a "poorly defined and complicated process."
"A pause in the June 1 launch of UHC's prior authorization policy requires the GI societies to publicly support this alternative proposal by early next week," the American Gastroenterological Association said in the release. "Our patients' health is at stake and we cannot meet this unreasonable request."
The societies said they "reaffirm our call on UnitedHealthcare to stop the GI prior authorization policy from going into effect June 1."
The three societies were among the 175 organizations that sent a letter to UnitedHealth Group CEO Andrew Witty on May 8 urging the company not to implement the new prior authorization process that they said will result in delays for medically necessary care, add unnecessary paperwork burden to physicians and staff, and may violate Center for Consumer Information and Insurance Oversight recommendations.
UnitedHealthcare has defended the policy. A spokesperson for the payer previously told Becker's:
"Clinical studies demonstrate overutilization of these procedures and lack of adherence to specialty society-endorsed guidelines and recommendations. Up to one-third of upper GI procedures and almost half of non-screening colonoscopies performed for common clinical conditions are not consistent with clinical guidelines. These studies also reveal a wide range of complications with endoscopy procedures, the most serious are bleeding, bowel perforation and anesthesia-related events such as aspiration pneumonia and heart arrhythmias. Further, our review of relevant data demonstrates a two to five practice level variation in the use of both upper and lower endoscopy procedure types, even after adjusting for member characteristics including age and comorbidities."