The American Gastroenterological Association has issued a statement regarding UnitedHealthcare's new gold card prior authorization program, which is set to take effect Oct. 1.
The program will reward contracted provider groups that "consistently adhere to evidence-based care guidelines," according to an Aug. 1 policy update from UnitedHealthcare. The program will apply to all UnitedHealthcare commercial, individual exchange, Medicare Advantage and community plans.
Physician practice will be required to give UHC advanced notification before performing services to "confirm member eligibility and coverage for the service(s) requested."
"This program, which comes with few details to date, is concerning to many gastroenterologists who see this as a familiar strategy by UHC to implement prior authorization for various procedures, including life-saving colonoscopies and endoscopies for the millions of patients who need them," AGA President Maria Abreu, MD, wrote in an Aug. 7 news release from the organization.
"UHC's announcement comes despite a growing movement of physicians, patients, and policymakers at both the state and federal levels to curb prior authorization practices that disrupt patient care through delays and denials of coverage and question physicians' medical judgment."
UHC previously had floated a similar gold card requirement for certain endoscopy and colonoscopy procedures.
"We remain disappointed that UHC continues a pattern of releasing information to the media first and bypassing medical societies — just as it did last year when a public firestorm forced it to pull back a prior authorization proposal in the final hour, again, notifying only the media hours before that it would implement an alternative program requiring the same administrative burden," Dr. Abreu said in the statement.
The AGA is working with Congress to urge UHC to provide more data and information on the program and on prior authorization requirements.
"Ultimately, our concern is for our patients. UHC's 'Gold Card' program risks disrupting their access to timely care. … With colorectal cancer rates rapidly rising among younger Americans, it is especially important for UHC to refrain from imposing barriers to the vital care that can catch concerning polyps at an early, more treatable stage," Dr. Abreu said. "Delays in therapy risk unnecessary hospitalizations and possible surgery."
"Prior authorization is an important checkpoint that helps ensure our members are receiving coverage for safe, effective care supported by the most up-to-date clinical guidelines. We’re introducing our first-of-its-kind national Gold Card program on October 1, recognizing provider groups who consistently adhere to evidence-based guidelines. The UnitedHealthcare Gold Card program is the next step in our continual efforts to modernize the prior authorization process and simplify the healthcare experience for consumers and providers," a UHC spokesperson told Becker's. "Prior authorization isn’t required for most gastroenterology procedures. Gastroenterology provider groups who meet the criteria will be included in the program. We haven't announced any plans to introduce prior authorization for GI procedures in 2024."