Why gastroenterologists 'breathed a sigh of relief' when UHC rolled back prior authorization plans

In June, UnitedHealthcare announced its new advanced notification for patients undergoing esophagogastroduodenoscopies, capsule endoscopies, diagnostic colonoscopies and surveillance colonoscopies. 

While gastroenterologists were happy to see that the originally proposed prior authorization rules would no longer take effect, several gastroenterology groups still expressed concern and distrust of the advanced notification and gold carding process. 

Benjamin Levy, MD, a gastroenterologist at University of Chicago Medicine, told Becker's that while advanced notification is a much better option than prior authorization, gastroenterologists are still anxiously watching to see how the program unfolds. 

"Many gastroenterologists are concerned about prior authorization and advanced notification processes causing delays in cancer diagnosis for patients with alarm symptoms and medical management in general. As a physician community, we breathed a sigh of relief when the proposed new prior authorization requirements were changed to advanced notification.

"The advance notification process increases administrative responsibilities for physicians and gastroenterology practices, where instead, we should be focused on expediting care. 

Gastroenterologists want the best possible and most efficient care for our patients. Prior authorization changes have the potential to cause 1) delays in care; 2) cause some patients to potentially abandon important colonoscopy procedures due to authorization difficulties; 3) increase the need for additional medical staff to process administrative requirements. 

"Gastroenterologists are curious to learn more about the previously-announced gold card program and the potential to eliminate prior authorization requirements. However, we are concerned that gastroenterologists who do not participate in the UnitedHealthcare 'advance notification' period might not be eligible for the gold card program, which could lead to more administrative work and delays in care.  

"We hope that UnitedHealthcare will work closely with the American College of Gastroenterology, the American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy leaders to improve the delivery of gastroenterology care and to get their input."

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