UnitedHealthcare’s announcement that it will reduce prior authorization requirements by 30% across its commercial, Medicare Advantage and ACA marketplace plans has drawn cautiously positive responses from physician groups, who say the changes are welcome but fall short of the lasting reform medicine needs.
The changes, effective Oct. 1, cover 1,700 diagnostic codes across all UnitedHealthcare commercial, Medicare Advantage and ACA plans. The newly exempted procedures cover a broad range of clinical specialties, from cardiology to physical therapy.
For GI practices specifically, the American College of Gastroenterology noted several notable wins: prior authorization requirements are being lifted for colonoscopy, esophagogastroduodenoscopy, esophagoscopy and liver biopsy on commercial and ACA plans. Additionally, UHC will eliminate its “advanced notification” requirement for diagnostic and surveillance colonoscopies, EGD and capsule endoscopy, a requirement the insurer introduced in 2023 after its original prior authorization proposal drew sharp opposition from ACG and the broader GI community.
UHC will also drop site-of-service necessity reviews for certain endoscopy services and screening colonoscopies performed in outpatient hospital settings.
UHC has also pledged to eliminate two-thirds of pediatric prior authorization requirements by the end of 2026, and 70% of its prior authorizations will be part of a new standardized submission process by year’s end. The insurer has also expanded support for rural healthcare communities by exempting many rural care providers from prior authorization requirements, with the program set to expand to approximately 1,500 rural hospitals, including all Critical Access Hospitals, by fall 2026.
ACG said it will continue to push for legislative reforms including the Safe Step Act, which would create a clear exception process for step therapy protocols, and the Improving Seniors’ Timely Access to Care Act, which would establish an electronic prior authorization process and improve transparency for Medicare Advantage plans.
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