GI societies, UnitedHealthcare meet to discuss controversial prior authorization changes

UnitedHealthcare is expected to change its prior authorization requirements for gastroenterology care June 1. 

The proposed changes have been controversial, with prominent GI organizations expressing concerns and even urging UnitedHealthcare to rethink the policy. 

UnitedHealthcare believes that the changes will be best for patients by improving safety and preventing procedure overutilization. 

Last week, UnitedHealthcare requested a meeting with the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy to discuss the new policy. 

According to a May 26 email sent to Becker's, "UHC has not been able to clearly articulate the need for such a sweeping prior authorization program." 

The GI societies have been asking UHC to share internal data that justifies prior authorization for 61 endoscopy codes, according to the email. 

In the meeting, UHC told the societies that it would discuss "delaying the new GI prior authorization program 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," the email said.

"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," the societies told Becker's. "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." 

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