United Healthcare (UHC) announced it will implement a new prior authorization program on Oct. 1, “which will reward contracted provider groups who consistently adhere to evidence-based care guidelines.”
Physician practices that are accepted into the program must notify UHC in advance of services to “confirm member eligibility and coverage for the service(s) requested.” That step is not a Gold Card. It sounds like prior authorization by another name.
This program, which comes with few details to date, is concerning to AGA – we see this as a familiar strategy by UHC to implement prior authorization for various procedures, including life-saving colonoscopies and endoscopies for the millions of patients who need them.
AGA will continue to be relentless in pushing UHC for details and transparency. We will also continue to push for meaningful reforms on prior authorization and other utilization management policies that hurt patients by delaying much needed care.
Hear more from our Dr. Abreu in this Becker’s article: American Gastroenterological Association slams UnitedHealthcare gold card program
