Prior Authorization Changes for United Healthcare
UPDATE 6/1/2023:
As of Thursday, June 1st UnitedHealthcare confirmed that starting this month, it will no longer require “prior authorizations” for patients with commercial plans seeking non-screening colonoscopies and other gastroenterology endoscopy services. Instead, they are requiring “advance notification” for such services. While yes, as of now we are not required to submit a prior authorization, having to take additional steps prior to a procedure is extremely problematic. This will still result in significant administrative burdens for physicians, administrative, and medical staff, which in turn will delay patient care.
Learn more about this program at the link below:
https://edition.cnn.com/2023/06/01/health/unitedhealthcare-colonoscopy-requirements/
We still urge you to reach out to United Healthcare to express your concerns about this new requirement at the link below.
On June 1st, United Healthcare (UHC) plans to implement a policy where gastrointestinal endoscopy will require prior authorization. Prior authorization means that UHC will have to approve and give permission for the procedure otherwise they will not cover the procedure. This means that after seeing your doctor or advanced practice provider if an endoscopic procedure is indicated and ordered, additional permission from UHC must be obtained before the procedure will be covered. Prior authorization may take weeks or months to process. This is a new hoop the insurance company has set for its members to jump through in order to get medically necessary diagnostic and therapeutic procedures. These extra steps delay care for patients and can even lead to treatment abandonment due to the limiting of access. Screening colonoscopies are excluded from prior authorizations; however, surveillance procedures – after polyps or cancers have been previously removed – or diagnostic testing for patients with red flag symptoms will require an additional prior authorization. UHC claims that this program is to ensure appropriate care for their members and prevent overutilization of procedures but the overarching scope of this policy clearly is designed to control costs by limiting care. Patients, GI organizations, and GI practices have voiced their concerns about this policy and it is up to UHC to choose patient care over their bottom line.
Learn more about these changes, and how they can affect you, at the links below:
How can you help?
While we advocate for you, our patient, you can help by telling United Healthcare how this change in prior authorizations will impact you by sending them a letter. The following link provides additional details.
https://gastro.org/news/tell-unitedhealthcare-to-stop-new-prior-authorization-requirements/
– Published May 31, 2023
By: Dr. Christopher Jue
He works at our Kernersville and Tanglewood locations.
Learn more about him here: https://digestivehealth.ws/provider/christopher-t-jue-md/
Digestive Health Specialists, PA is here to help if you, or someone you know, would like more information, or if you are experiencing any digestive health symptoms and would like further evaluation. Feel free to give us a call at 336-768-6211 or fill out the form below.
