The American Gastroenterological Association has written a letter to UnitedHealthcare on behalf of its physician members urging the insurer to withdraw its advanced notification program, which went into effect on June 1.
The letter also urges UHC not to implement its "gold card" prior authorization program, which is set to go into effect in 2024.
The letter flags three key areas of concern:
1. The AGA is requesting UHC's deidentified aggregate data on which the advanced notification is based.
2. It is requesting clarification on whether or not GIs not participating in the advanced notification program will be automatically subject to prior authorization in 2024 when the gold card program launches.
3. It is requesting specific details on how information gathered through advanced notification will shape the gold card program.
"Despite multiple requests, you have not shared any UnitedHealthcare specific overuse or variation data on a code-by-code basis that would warrant such a burdensome process. Please share the deidentified aggregate data. Absent data, there is no rationale for such a policy," the AGA wrote Aug. 1. "The advance notification program directly contradicts UnitedHealthcare's publicly stated goals of reducing administrative burden and streamlining access to care — goals we support and encourage you to work toward in the gastroenterological specialty. In contrast, advance notification is imposing significant administrative burdens on physician practices, which will negatively impact patient access to timely, medically necessary care."
The letter also emphasized a practice burden placed upon physicians and their employers since the advanced notification program began, outlining seven key issues heard from members around the country:
1. Most local UHC representatives are unaware of advanced notification and are unable to advise practices regarding concerns and questions.
2. Local UHC representatives have no information on the gold card program or how it will operate.
3. Many practices have not received follow-ups from UHC after requesting additional records for advanced notification submissions.
4. Some practices quantify the advanced notification process as adding 25 to 35 percent more work for employees.
5. Practices with large UHC volume have to divert multiple staff members to work full-time on UHC accounts.
6. Information required is the same as other UHC prior authorizations.
7. GI practices calling the help number to report a change in procedure spend an average of an hour on hold per case.
"AGA is troubled by the serious lack of specific details about the Gold Card prior authorization program to date. With less than six months until 2024, UnitedHealthcare has not issued any details about eligibility criteria, participation, or what new prior authorization requirements may be implemented for practices that do not qualify for a Gold Card," the letter says. "We resolutely oppose the implementation of any type of pre-authorization requirements for colonoscopies and endoscopies. We are medical practitioners who have years of training and experience treating patients. Our medical decisions are evidence-based, which no prior authorization policy can claim."