UHC offers to trade GI prior auth for a poorly defined alternative

After weeks of being questioned by patients and GI providers about a new prior authorization policy planned to go into effect June 1, UnitedHealthcare requested a meeting today with the American College of Gastroenterology, American Gastroenterological Association and American Society for Gastrointestinal Endoscopy.

The fact is that UHC has not been able to clearly articulate the need for such a sweeping prior authorization program. For weeks the GI societies have been asking UHC to share internal data that justifies prior authorization for 61 endoscopy codes, including low-volume codes.

UHC’s stated purpose of today’s meeting was to discuss delaying their 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.

Unfortunately, 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.

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.

The GI societies reaffirm our call on UnitedHealthcare to stop the GI prior authorization policy from going into effect June 1.

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