Joint Society Statement: 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 (UHC) requested a meeting today with the ASGE, as well as, ACG and AGA. 

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. 


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.

 

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