UnitedHealthcare, an insurer of 45 million patients worldwide, has announced changes to its prior authorization requirements for gastroenterology care, set to take effect June 1.
New requirements will require patients on a United commercial plan to seek prior authorization for gastroenterology endoscopy services.
Practicing gastroenterologists are not happy about the change, warning that it could have potentially dire consequences for GI patients.
Already, physicians report prior authorization challenges causing delays to necessary medical care for patients up to 94 percent of the time, according to a survey from the American Medical Association.
Almost half of physicians (46 percent) have had patients sent to immediate care of the emergency room because of necessary treatment delays caused by prior authorization.
Gastroenterologist Linda Lee, MD, medical director of endoscopy at Boston-based Brigham and Women's Hospital and associate professor of medicine at Boston's Harvard Medical School, warns patients to stay away from United once these changes take effect.
Dr. Kee shared the following in an email to Becker's on March 16.
Dr. Lee: UnitedHealthcare continues to make the wrong decisions when it comes to providing their patients with the best care. We all know that requiring prior authorizations really only leads to more bureaucracy within the insurance company, as well as within each healthcare provider’s practice, because now we need people to fill out these prior authorization forms, waste time trying to get through their 1-800 number to speak with someone who has no clinical knowledge, then be told we need to speak with someone else who actually does have some medical (albeit not GI) knowledge about why these procedures are necessary.
This thereby leads to increased costs because we all need to hire more people to handle these needless requests. However, most importantly, this will lead to poorer patient care with delays in care as we are struggling to wade through the morass of prior authorization while the patients are bleeding, not able to swallow, vomiting and more while waiting for their insurance company to approve their potentially life-saving procedures.
The insurance company apparently knows better than a physician who has been trained through medical school, residency and fellowship what procedures are needed for patients. All four procedures that UnitedHealthcare is requiring prior authorizations for soon have very well documented medical indications for them, and this truly makes no sense and is driving healthcare the wrong way. Patients should flee from UnitedHealthcare as their insurance provider.