GI advocates block prior authorization for lifesaving procedures

Gastroenterology advocates voiced strong opposition to a policy by United Healthcare (UHC) that would have required prior authorization for colonoscopies and endoscopies.

“UHC’s new prior authorization requirements target critical GI services that help physicians catch and diagnose life-threatening diseases like colorectal cancer earlier, giving patients a better chance of survival, as well as procedures that are necessary to monitor disease progression in patients,” Department Chair Dr. Barbara Jung wrote in an op-ed on May 26. Jung is the president of the American Gastroenterological Society (AGA).

As a result of the push back by the AGA and other GI societies, the UHC ultimately changed course and implemented an advance notification process, instead of prior authorization, for non-screening and non-emergent GI procedures. The advance notification process went into effect on June 1, and GI organizations are continuing the fight.

“UnitedHealthcare’s slap-dash approach to rolling out a policy that will ultimately control patient access to critical, often life-saving, medical procedures flies in the face of common sense and responsible medical practice,” said Jung. “It also indicates that UHC does not currently have data that shows any significant overutilization of critical endoscopy and colonoscopy procedures that would ostensibly justify this program or prior authorization.”