UnitedHealthcare backs off controversial GI prior authorization policy

UnitedHealthcare is not implementing a gastroenterology endoscopy prior authorization policy set to take effect June 1 and instead will set up an advance notification process for non-screening GI procedures.  

"To provide an opportunity for physician education and to allow us to collect more data on which physicians should be eligible for our previously announced 2024 gold card program, effective immediately, we will be implementing an advance notification process, rather than prior authorization, for non-screening and non-emergent GI procedures," a UnitedHealthcare spokesperson told Becker's in an emailed statement June 1. "This advance notification will not result in the denial of care for clinical reasons or for failure to notify and will help educate physicians who are not following clinical best practices. Provider groups who do not submit advance notification during this period will not be eligible for the UnitedHealthcare gold card program."

UnitedHealthcare said screening colonoscopy procedures are not subject to the advance notification process.

GI societies have pushed back against the prior authorization proposal that was first announced in March. In May, 175 organizations sent a letter to UnitedHealth Group CEO Andrew Witty urging the company not to implement the new prior authorization process, which 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.

The payer on May 26 met with representatives from the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy to discuss the advance notification proposal. The GI societies opposed the proposal and said they were "not in a position to appropriately evaluate the UHC proposal with the limited information presented."

An AGA spokesperson told Becker's in a June 1 emailed statement that since that meeting, the organization has "received extremely limited details about this newly proposed program — aside from a proposed framework that would mandate physicians to provide even more data on top of the current burdensome paperwork requirements."

"UnitedHealthcare's slapdash approach to rolling out a policy that will ultimately control patient access to critical, often lifesaving, medical procedures flies in the face of common sense and responsible medical practice," AGA President Barbara Jung, MD, said in the statement. "It also indicates that UHC does not currently have data that shows any significant overutilization of critical endoscopy and colonoscopy procedures that would ostensibly justify this program or prior authorization."

The American Hospital Association said in an email shared with Becker's that it discussed concerns over the prior authorization policy with UnitedHealthcare on May 31. The AHA said it raised concerns that prior authorization requirements would potentially reduce access to care, especially for vulnerable populations. 

"We appreciate UHC refocusing its GI policy on provider education to address member concerns about potential care denials and additional preauthorization requirements," AHA president and CEO Rick Pollack said in a statement. "We plan to collaborate with UHC to help ensure it meets its goal of providing meaningful education for providers while proactively addressing these concerns."

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