From new prior authorization rules to growing payer contracts, here are six GI payer updates from 2024:
1. In September, Exton, Pa.-based US Digestive Health signed a five-year contract with major payer Highmark Health, an independent licensee of the Blue Cross Blue Shield Association. The contract ensures that Highmark members will have in-network access to US Digestive's specialized gastroenterologists in Pennsylvania and Delaware.
2. On Oct. 1, UnitedHealthcare launched its gold-card program, impacting nearly all physician specialties. Several GI-related codes were impacted by the program's launch, and will continue to be as long as the program is in place.
3. Two key GI organizations, the American College of Gastroenterology and the American Gastroenterological Association have expressed skepticism about the program.
4. A study found that many patients have been paying out of pocket for colonoscopy bowel prep despite a federal law stating it should be covered by insurance.
5. The costs and reimbursements associated with gastroenterology procedures are not keeping up with the increase in patient diagnoses. Here are five numbers that illustrate GI reimbursement challenges.
6. In January, Nebraska state Sen. Carol Blood proposed a bill stating that patients with insurance would not be subject to additional costs for medical services associated with a colonoscopy, such as a polyp removal. By February, the bill had passed three rounds of voting. The bill was approved by the state's governor in April.