UnitedHealthcare Expanding Prior Authorization for Gastroenterology

ASGE’s Delay Request Denied - Patients Must Wait for Authorization Before Care

UnitedHealthcare has announced that on June 1, 2023 it will begin requiring prior authorization for 61 gastrointestinal (GI) endoscopy codes — 47 percent of all GI endoscopy codes — for enrollees in its commercial plans. The announcement comes as some of the largest health insurance companies are under public scrutiny for prior authorization practices, including the use of artificial intelligence technology to speed prior authorization processes, that are resulting in denials of medically necessary care.

While health insurance companies may have found more economical ways to require prior authorization for a greater number of health care services, physician practices are struggling to keep up with the growing administrative burden of prior authorization and expending significant resources to fight coverage denials that are frequently overturned on appeal while their patients wait for care. 

On March 29, 2023 UnitedHealthcare reported it is eliminating nearly 20 percent of current prior authorizations. Meanwhile, UnitedHealthcare is poised to require prior authorization of potentially hundreds of thousands of new GI services. If UnitedHealthcare was genuinely committed to easing the prior authorization process for providers, it would have agreed to ASGE’s request to delay the new prior authorization requirements for GI endoscopy services while ASGE and other GI medical societies attempt to work with the company to ensure prior authorization is targeted only where it is needed. Instead, UnitedHealthcare is giving physicians just 90 days to prepare for the new GI prior authorization requirements. 

About Gastrointestinal Endoscopy
Gastrointestinal endoscopic procedures allow the gastroenterologist to visually inspect the upper gastrointestinal tract (esophagus, stomach and duodenum) and the lower bowel (colon and rectum) through an endoscope, a thin, flexible device with a lighted end and a powerful lens system. Endoscopy has been a major advance in the treatment of gastrointestinal diseases. For example, the use of endoscopes allows the detection of ulcers, cancers, polyps and sites of internal bleeding. Through endoscopy, tissue samples (biopsies) may be obtained, areas of blockage can be opened and active bleeding can be stopped. Polyps in the colon can be removed, which has been shown to prevent colon cancer.

About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with almost 17,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit Asge.org and ValueOfColonoscopy.org for more information and to find a qualified doctor in your area.

 

American Society for Gastrointestinal Endoscopy
3300 Woodcreek Drive Downers Grove, IL 60515
P (630) 573-0600
F (630) 963-8332

Media Contact

Andrea Lee
Director of Marketing and Communications
630.570.5603
ALee@asge.org