On June 1, UnitedHealthcare launched a new advanced notification process that requires physicians and practices to submit information on patients undergoing esophagogastroduodenoscopies, capsule endoscopies, diagnostic colonoscopies and surveillance colonoscopies.
The new process has been met with disapproval from industry leaders and physicians, including the American Gastroenterological Association.
A month after the new program's launch, the AGA "remains concerned" about the advance notification program, according to a July 6 press release sent to Becker's.
The AGA is most concerned that UHC is using the new process as a basis for its "gold card" prior authorization program, which is set to launch in 2024 and could force 27.4 million commercial beneficiaries to undergo long waits for time-sensitive endoscopy and colonoscopy procedures.
"UnitedHealthcare's haphazard approach to rolling out a policy that will ultimately control patient access to critical, often lifesaving, medical procedures is the opposite of what should be our common goal of expeditious access to essential care," Barbara Jung, MD, president of the AGA, said in the release. "AGA has expressed our willingness to work collaboratively with UnitedHealthcare to address any concerns and educate physicians, but communication and transparency with the insurer are nearly non-existent. Instead, the GI community is confronted with a nebulous concept called advance notification, which is not conducive to seamless patient care. Ultimately, it appears advance notification will form the basis of prior authorization, which we know can delay, disrupt and deny timely care."
Advance notification now requires physicians to input general patient information for every procedure.
"GI practices report that United's online portal is confusing and lacks a standard software application, creating a chaotic process for physicians across the country — all with different Electronic Medical Record applications. For the data to be useful at all, it must be accurate, an issue United has yet to address even though the program has been in effect for more than a month," the AGA said in its release. "UHC's effort to misrepresent its ultimate intention is clear. It speaks volumes that UHC has not released any information about how it will implement its planned 'Gold Card' prior authorization program or why it is requiring so much burdensome data collection from doctors' offices at this point."