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UHC's Alternative Proposal to Prior Authorization Policy Rejected by GI Docs

Analysis  |  By Jay Asser  
   May 31, 2023

The two sides remain apart as the payer's prior authorization mandate is set to begin on June 1.

A meeting between UnitedHealthcare (UHC) and the American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy failed to produce a resolution in the fight over the insurer's prior authorization policy, the societies said.

The payer and GI providers convened for a meeting in which UHC proposed delaying its GI prior authorization program, which goes into effect June 1, "in exchange for an 'advance notification program,' requiring GI practices and staff to gather detailed patient data prior to procedures and in preparation for a Gold Card program in 2024," according to a joint press release by the societies.

"Unfortunately, what UHC verbally presented in our meeting was a poorly defined and complicated administrative process. The GI societies are not in a position to appropriately evaluate the UHC proposal with the limited information presented.

"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. Our patients' health is at stake and we cannot meet this unreasonable request."

The societies reaffirmed their desire for UHC to halt its prior authorization policy, which will require approval for nearly half of gastrointestinal endoscopies.

In a response to HealthLeaders about the prior authorization program, UHC said:

"We have made no changes to our policy regarding screening colonoscopies for preventive care, and this policy does not impact screening colonoscopies. We are asking physicians to follow the guidelines and evidence-based practices developed by their own gastroenterology medical societies to help ensure our members have timely access to safe and clinically appropriate care. The physicians who will be most affected by this new policy are those who are not already following these evidence-based practices, which again, were developed by gastroenterology-related medical societies."

"Our electronic submission process allows for immediate approvals for physicians who have a history of following evidence-based guidelines for the requested procedure. For procedures that do not receive immediate approval, decisions are typically made within two business days after receipt of all required clinical information needed for our GI specialists to review the case – well within the average wait time to schedule a service included in this policy."

Jay Asser is the contributing editor for strategy at HealthLeaders. 


GI societies met with UnitedHealthcare over the payer's prior authorization program, but did not accept the insurer's proposal to delay the policy from going into effect in exchange for a "poorly defined and complicated administrative process."

The societies said they did not have enough information to properly evaluate and publicly support the proposal ahead of the policy going into effect on June 1.

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