On April 12, ACG, AGA and ASGE met with UnitedHealthcare (UHC) to discuss its plan to require prior authorization for GI endoscopy procedures for its commercial plans starting June 1, 2023. UHC scheduled this meeting with the societies to respond to previously expressed questions and concerns. As a follow-up, the GI societies requested UHC provide code-specific data to support its prior authorization program that would target GI services. (See UHC policy announcement, FAQs, impacted codes and code crosswalk.)
UHC is not willing to delay implementation of this policy or decrease the number of physicians impacted by the program, even though it has announced plans to eliminate at least 20% of its current prior authorizations and will introduce a Gold Card program in 2024.
These two policy strategies are contradictory to UHC's plans to create a new prior authorization program for GI services, and our societies are deeply concerned that implementation of this program will exacerbate health disparities, create additional barriers to care for the most vulnerable populations and add to already overwhelming administrative burden on physician practices.