UnitedHealthcare had been preparing to implement a policy beginning on June 1, 2023 that would have required prior authorization for most GI endoscopic procedures, including colonoscopies. The policy was strongly opposed by provider groups including the American Hospital Association, the American Gastroenterological Association, the American College of Gastroenterology, the American Society for Gastrointestinal Endoscopy, and several state medical associations, who argued that the policy would harm patients and unnecessarily increase burdens on providers.
In the face of this united opposition, United rescinded the prior authorization policy and replaced it with a policy requiring advance notification of GI procedures. United stated that it would use the data collected by such notification to educate providers where appropriate and to exempt physicians routinely following United guidelines from prior authorization requirements under its gold-carding program in 2024.
Provider reaction to United’s replacement of the prior authorization policy for GI procedures with the notification policy was mixed. The American Hospital Association issued a statement attributed to its President and CEO Rick Pollack stating: “We appreciate UHC refocusing its GI policy on provider education to address member concerns about potential care denials and additional preauthorization requirements. We plan to collaborate with UHC to help ensure it meets its goal of providing meaningful education for providers while proactively addressing these concerns.”
The American Gastroenterological Association (“AGA”) welcomed the rescission of the prior authorization policy. In a press release addressing the new notification policy, however, AGA stated: “After weeks of protest from AGA and the GI community, UnitedHealthcare shelved the prior authorization policy for GI endoscopy…, but replaced it with a nebulous Advance Notification Program…This program requires [physicians] to provide even more data on top of the current burdensome paperwork requirements. It is a temporary patch – patients will not be denied care immediately, but the downstream effects of the program could be as bad or worse for patient access.”
Whatley Kallas, LLP’s previous article on a letter fom175 physician groups opposing United’s GI prior authorization policy is linked here. The American Hospital Association’s press release is linked here and AGA’s press release is linked here.