Although UnitedHealthcare has decided not to implement its planned prior authorization policy in favor of an ill-defined advance notification program, we are concerned that this replacement policy creates a new pretext for future prior authorization requirements, which will delay care and limit access to life-saving colonoscopy and other endoscopic examinations that prevent cancer.
The delay in implementing the onerous and unjustified prior authorization program may mean that patients won’t be denied care immediately, but the ensuing effects of the program could be as bad or worse for patient access.
Any policy that delays diagnosis and treatment of serious diseases, deters high-risk patients from undergoing procedures recommended by their gastroenterologist in accordance with clinical guidelines, or contributes to disparities in care and outcomes is unacceptable.
To make matters worse, UnitedHealthcare is continuing to place roadblocks in the way of patients receiving timely access to care – now in the form of an advance notification program – without presenting any data of overutilization of services that would justify this program.
It is also not clear what would be required for gastroenterology practices to be eligible for the UnitedHealthcare “Gold Card” program that will exempt patients from burdensome prior authorization requirements. We are concerned that practices will be required to provide even more data in addition to the burdensome paperwork currently required.
DHPA will continue to work with our fellow gastroenterology societies, physician and patient advocacy groups, state and federal policymakers, and the broader health care community to oppose any policies that limit patient access to life-saving colonoscopy and other endoscopic procedures that prevent cancer.