WASHINGTON, DC – The American Gastroenterological Association (AGA) is profoundly alarmed and disappointed by UnitedHealthcare’s (UHC) recently announced prior authorization requirement for gastroenterology endoscopy services for all commercial plans, regardless of the outpatient location. Despite recently trumpeting its decision to cut down on its use of prior authorization, UnitedHealthcare’s expansion of prior authorization for most physician-prescribed endoscopy procedures—effective June 1—could disrupt time-sensitive care for millions of patients and create needless anxiety and delays for patients who may have cancer or other serious gastrointestinal conditions.
UHC’s new prior authorization policy will impact esophagogastroduodenoscopies, capsule endoscopies, diagnostic colonoscopies, and surveillance colonoscopies. These services are critical for the early diagnosis of life-threatening diseases such as colorectal cancer and for monitoring patients’ disease progression. The policy could cause care delays for high-risk individuals, deter patients from undergoing medically recommended procedures, exacerbate existing sociodemographic disparities in care and outcomes, and add to the growing administrative burden on physicians.
This new policy comes despite immense pressure from physicians, patients, lawmakers, and regulators to crack down on abusive prior authorization policies. The AGA has met with UnitedHealthcare to highlight the patient harm this policy will cause and continues to advocate for the policy to be reversed. Over 1,000 AGA members have sent letters to UnitedHealthcare’s CEO decrying the new prior authorization requirements and urging the insurance giant to reverse course for the sake of patient health and safety.
With the prior authorization policy set to start impacting patients on June 1, time is running out for UHC to rescind prior authorization for endoscopy procedures so that critical care is not delayed.
“After years of education, training, and experience, I know when one of my patients needs an endoscopy procedure. Yet, for some reason, UnitedHealthcare thinks it knows my patients—and their healthcare needs—better than I do,” Lawrence Kim, MD, AGA vice president elect, gastroenterologist in private practice, Denver, Colorado. “It’s unfathomable that insurance bureaucracy can put up red tape to block high-risk patients from accessing the timely care needed to potentially save lives. UnitedHealthcare recently announced it will slash prior authorization requirements for a wide variety of services, a goal we share. In order to truly put patients first, UHC must immediately reverse its dangerous policy so America’s millions of GI patients can access the care they deserve,” Dr. Kim continued.
UHC’s decision to expand prior authorization policies to include GI endoscopies is the latest example of insurance company overreach—often with terrible consequences for patients. According to the American Medical Association (AMA), one-third (33%) of doctors say prior authorization has led to a serious adverse event such as hospitalization, permanent disability, or death for a patient in their care. In fact, 46% of physicians report that prior authorization has led to immediate care and/or emergency room visits.
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About AGA
The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, AGA has grown to more than 16,000 members from around the globe who are involved in all aspects of the science, practice, and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization. For more information, visit www.gastro.org.
