Digital Debut

UnitedHealthcare Requests Advance Notification for GI Procedures

The insurer rescinded its controversial prior authorization policy right before planned enforcement

BY ALEX TAIRA | JUNE 2023

ASCA and the health community’s efforts paid off with UnitedHealthcare (UHC) rescinding its controversial prior authorization policy implementation just as it was scheduled to take effect on June 1. However, the insurer is still requesting “advance notification” from providers that intend to perform any of the procedures that were previously part of the prior authorization policy, as well as screening colonoscopies, which were not part of the rescinded policy. Although the advance notification process will not result in any coverage denials, provider groups that do not submit advance notifications will not be eligible for UHC’s Gold Card program expected to launch in 2024. The insurer has not released exact details yet but has indicated that providers with gold card status will be exempt from existing or future UHC prior authorization requirements across all specialties.

UHC’s retraction came after several months of intense advocacy and grassroots activism from organizations across the healthcare spectrum, including ASCA and the main gastrointestinal (GI) specialty societies. On June 1, UHC announced that its prior authorization policy affecting almost all upper GI endoscopy, colonoscopy and capsule endoscopy procedures would not go into effect as expected.

In March 2023, the three primary GI-focused specialty societies, the American Gastroenterological Association, the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy, began a collaborative effort to push back against the policy. ASCA became heavily involved as well, recruiting members to send letters to UHC leadership, signing on to a letter with 24 other organizations and sending an individual letter on behalf of the ASC community in April. ASCA was also one of 175 groups that cosigned a letter sent to UHC on May 8 opposing the policy.

UHC is one of the largest, if not the largest, health insurers in the US reporting almost $250 billion in revenue in 2022 alone. The insurer first announced its intention to implement a prior authorization policy for GI procedures in February 2023. According to the policy, commercial plan members would be required to obtain prior authorization before performing any of 61 delineated GI procedures, many of which are performed commonly in surgery centers. Although the insurer declined to share research or data, UHC asserted that the policy was necessary to combat overutilization, which was passing on unwarranted costs to providers. UHC had previously stated an intention to roll back or expedite many of its current prior authorization policies, which made the announcement of the GI-focused policy perplexing.

Write Alex Taira with any questions.