The program aims to save patients and providers time by allowing qualifying providers to skip the prior authorization process for a number of procedure codes.
Providers remain split on the program, with some calling it a welcome change, while others expressing doubts about its effectiveness.
“The proposal behind the gold card program from UHC is one that will work to help alleviate pre-certification requirements if the program works as designed,” Zeeshan Tayeb, MD, owner and medical director of Pain Specialists of Cincinnati, told Becker’s. “The qualifying criteria for provider enrollment is something that will help raise the standards of care for all patients receiving treatment.”
Other advocacy groups, including the American Gastroenterological Association, expressed reservations and pointed to risks within the program.
“Ultimately, our concern is for our patients. UHC’s gold card program risks disrupting their access to timely care. … With colorectal cancer rates rapidly rising among younger Americans, it is especially important for UHC to refrain from imposing barriers to the vital care that can catch concerning polyps at an early, more treatable stage,” Maria Abreu, MD, AGA’s president told Becker’s.
“We’re introducing our first-of-its-kind national gold card program on Oct. 1, recognizing provider groups who consistently adhere to evidence-based guidelines. The UnitedHealthcare gold card program is the next step in our continual efforts to modernize the prior authorization process and simplify the healthcare experience for consumers and providers,” a UHC spokesperson told Becker’s.
United’s new gold card eligible procedure codes will go into effect on Oct. 1. Find a full list of eligible procedures here.
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