The nation’s most profitable insurer has yet to release clear information about its new program that went into effect on June 1, which lays the groundwork for UHC’s prior authorization policy for lifesaving colonoscopies and endoscopies.
WASHINGTON, July 6, 2023 /PRNewswire/ — The American Gastroenterological Association (AGA) remains concerned by UnitedHealthcare’s (UHC) advance notification program, which went into immediate effect June 1. The nation’s most profitable insurer has yet to provide clear requirements, instructions or training––sowing confusion and uncertainty among doctors and their staff. Most importantly, AGA remains alarmed that the insurance giant is using this program as a basis for its “Gold Card” prior authorization program, which could force its 27.4 million commercial beneficiaries to wait for time-sensitive endoscopy and colonoscopy procedures when it goes into effect in early 2024. Because timely care is critical for treating colorectal cancer—the nation’s second most fatal cancer—and other serious gastrointestinal diseases, any delays caused by UnitedHealthcare’s policies could increase the risk of disease progression, deferred care and cancers going undetected.
“UnitedHealthcare’s haphazard approach to rolling out a policy that will ultimately control patient access to critical, often lifesaving, medical procedures is the opposite of what should be our common goal of expeditious access to essential care,” said Barbara H. Jung, MD, president of the AGA. “AGA has expressed our willingness to work collaboratively with UnitedHealthcare to address any concerns and educate physicians, but communication and transparency with the insurer are nearly non-existent. Instead, the GI community is confronted with a nebulous concept called advance notification, which is not conducive to seamless patient care. Ultimately, it appears advance notification will form the basis of prior authorization, which we know can delay, disrupt and deny timely care.”
Thus far, advance notification requires doctors to input general patient information for every procedure. GI practices report that United’s online portal is confusing and lacks a standard software application, creating a chaotic process for physicians across the country – all with different Electronic Medical Record applications. For the data to be useful at all, it must be accurate, an issue United has yet to address even though the program has been in effect for more than a month.
The lack of information about the advance notification program concerns gastroenterologists who fear this new program is simply a way for UHC to collect patient data for its eventual roll out of its “Gold Card” prior authorization program early next year. When implementing prior authorization, many insurers cite such “utilization management” policies as a way to address an overuse (or overutilization) of certain healthcare services that may not be necessary for each patient receiving them. In this case, however, it is clear that UHC does not currently have any data indicating significant overutilization of critical colonoscopy and endoscopy procedures—and therefore no justification to impose burdensome barriers like prior authorization.
In recent years, several states have created “Gold Card” programs to erect guardrails around prior authorization, streamline patients’ access to care, promote transparency, and avoid potentially harmful delays and denials to address the encroachment of insurers implementing this policy. Yet, UHC’s so-called “Gold Card” program for critical colonoscopy and endoscopy procedures does not limit prior authorization; instead, it is a means for implementing the troubling practice. UHC is using a name that many state legislatures have applied to bills – that are now law – and is synonymous with controlling insurer overreach into medical decision-making. UHC’s effort to misrepresent its ultimate intention is clear. It speaks volumes that UHC has not released any information about how it will implement its planned “Gold Card” prior authorization program or why it is requiring so much burdensome data collection from doctors’ offices at this point.
As rates of colorectal cancer rise among young adults, UHC should not put barriers for essential care in place. Virtually all colonoscopies and endoscopies will be impacted for UHC’s commercial plans under this program. Given the sheer size and scope of the advance notification program and 2024 “Gold Card” prior authorization program, the lack of information and direction is reckless.
Discussing the early impact of UHC’s advance notification program, Lawrence Kim, MD, AGAF, vice president of AGA and a gastroenterologist practicing in Denver said: “There is a lot of duplicate entry of demographic information and sometimes phone calls are required, which can take up to 30 minutes each. We are currently completing 30-40 notifications a day, requiring two staff members to comply with this program. UHC is not asking for any clinical information, just procedure and diagnosis codes, and in some cases site of service. Therefore, the advance notification program as it stands will not provide UHC with any additional information beyond what they already have through claims data. This highlights the strain these requirements are putting on providers and practices for repetitive data.”
Research suggests there is an unmet need for colonoscopies in the United States meaning there is an underutilization of this crucial procedure. The AGA will continue to work closely with our members to ensure their access to medically necessary procedures.
About AGA
The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, AGA has grown to more than 16,000 members from around the globe who are involved in all aspects of the science, practice, and advancement of gastroenterology. The AGA Institute administers the practice, research, and educational programs of the organization. For more information, visit www.gastro.org.
AGA is collecting stories and data about how UHC’s GI advance notification policy is affecting patients and practices at www.gastro.org/StopUHC.
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SOURCE American Gastroenterological Association
