Multibillion-dollar insurance giant UnitedHealthcare Group is the largest health insurance company in the U.S. by market share. Here are five of the company's most impactful healthcare moves in 2023, as determined by Becker's page views:
1. UnitedHealthcare's first of two waves of prior authorization cuts started Sept. 1. The first wave eliminated 20% of its current prior authorization requirements, and the second and final wave in November included cuts to community plans.
2. UnitedHealthcare is discontinuing some Medicare Advantage plans and exiting some service areas for 2024. In a message sent to providers, the insurer said affected plans include some plans co-branded with AARP; UnitedHealthcare MedicareDirect, a fee-for-service-based program; some dual-eligible plans; and other MA options. However, a UnitedHealthcare spokesperson told Becker's the company is expanding its overall Medicare Advantage offerings for 2024.
3. UnitedHealthcare revamped planned prior authorization policy changes after receiving pushback from medical groups and other organizations.
The insurer planned to implement new gastroenterology and endoscopy prior authorization policies June 1 but decided to enact an advance notification policy for non-screening and nonemergent GI procedures.
Gastroenterology societies and other organizations pushed back against the proposed policy, arguing it would result in delays for medically necessary care, add unnecessary paperwork burden to physicians and staff, and may violate Center for Consumer Information and Insurance Oversight recommendations.
The company then reworked its policy; however, the replacement policy was also met with criticism. Experts argued the reworked policy would still limit patient access to lifesaving procedures and that there is no evidence of overuse of the affected GI procedures that would make the restrictions necessary.
4. UnitedHealthcare plans to enhance the benefits of its UCard, an integrated insurance ID card with many uses for members.
The UCard is for Medicare Advantage and D-SNP members to use as a traditional insurance ID card to access care and fill prescriptions, along with offering a way to pay for healthy food and over-the-counter products at certain retailers, pay for utilities and check in at the gym, if eligible.
In 2024, UnitedHealthcare is expanding its MA plans to reach 96% of all Medicare-eligible individuals.
5. UnitedHealthcare was hit with a lawsuit by Greenville, S.C.-based Prisma Health that alleged the company breached its contract by disclosing information about Prisma's rate proposals to media outlets and not providing a copy of any statement to the media to Prisma 48 hours before publication. The health system requested a temporary injunction preventing UnitedHealthcare from disclosing further information.
UnitedHealthcare responded, saying it did not breach its contract with Prisma and that the health system "coordinated a media effort to put pressure" on the insurance giant. The companies were in the midst of negotiating a new contract.