The American Society for Gastrointestinal Endoscopy (ASGE), alongside the American College of Gastroenterology (ACG) and the American Gastroenterological Association (AGA), have asked UnitedHealthcare (UHC) to rescind plans to require prior authorization for GI endoscopy procedures for its commercial plans starting June 1, 2023. When the prior authorization program takes effect, 61 endoscopy codes — or nearly 50 percent of GI endoscopy services — will be subject to review.
In a March 29, 2023, news release, UHC promised to ease prior authorizations, stating it plans on “eliminating nearly 20 percent of current prior authorizations, as part of a comprehensive effort to simplify the health care experience for consumers and providers.” The GI societies have argued that proceeding with the prior authorization program for endoscopy services is contradictory to UHC’s stated intent. The GI societies are also frustrated with UHC’s refusal to share data that substantiates its claims of over-utilization and geographic variation of endoscopy services, including for low-volume endoscopy services.
In its March announcement, UHC also stated it will use “improved automation and faster decision-making” to create an “enhanced prior authorization experience.” Because of the significant volume of GI endoscopy services that will be subjected to prior authorization, ASGE is concerned about the potential use of AI systems that flag mismatches between diagnostic codes and the services the insurers find acceptable for those conditions.
“Insurance companies have found more economical ways through automation to move a large volume of services through prior authorization rather than narrowing the scope of review to those services for which the payers can provide current evidence of clinically inappropriate use or geographic variation,” said Bruce Hennessy, MD, Chair of ASGE’s Health and Public Policy Committee.“ AI makes it very easy for payers to implement prior authorization for even low-cost tests and services, effectively passing the cost and administrative burden of more prior authorizations to physician practices.”
Over the past month, the GI societies have met twice with UHC representatives and undertaken activities designed to stop UHC’s implementation of its prior authorization program for endoscopy and to highlight to policymakers and the public why federal reforms are needed to ease the burden of prior authorization on physician practices and its contribution to burnout among physicians.
ASGE is urging its members to get involved by contacting state lawmakers and UHC and speaking out on social media. Take these three steps using tools provided by the three GI societies:
- Contact your state policymakers
- Contact UnitedHealthcare now
- Use your voice on social media; access social media tools