.jpg)
Citing overutilization, a new nationwide UnitedHealthCare (UHC) policy piles on to physicians’ prior authorization hassles, now requiring preappovals for many gastroenterology endoscopy services that take place on or after June 1.
In Texas, the change will affect all UHC commercial plan members.
While routine screening colonoscopy procedures are not included in UHC’s update, the following patient services will now require separate prior authorization even if performed at the same time as each other, including:
- Upper endoscopies, or esophagogastroduodenoscopies (EGD),
- Capsule endoscopies, and
- Diagnostic and surveillance colonoscopies.
UHC pointed to “overutilization of invasive non-screening (surveillance and diagnostic) colonoscopies, EGD, and capsule endoscopy procedures in certain situations that expose patients to unnecessary risk and costs” as reason for the change in its newly released FAQ sheet.
On the contrary, physicians continue to report that prior authorization delays cause patients to wait longer for necessary medical care, among other problems.
The Texas Medical Association will be meeting with each of the major insurance companies in the coming months to discuss the administrative burdens the new UHC policy and others may cause. TMA also is concerned about the contribution of such burdens to physician burnout, and the impact of payment delays on access to care.
In the meantime, physicians can submit a prior authorization request to UHC by:
The prior authorization request will be valid for 90 calendar days, which begins on the issue date of the prior authorization number.
TMA encourages physicians whose practices and patients have been negatively impacted by prior authorization to share their stories. To share questions or concerns, call TMA’s billing and coding hotline at (512) 370-1414 to speak directly with one of TMA’s certified coders or visit TMA’s Reimbursement, Review, and Resolution Service page.
Last Updated On
March 28, 2023
Originally Published On
March 28, 2023
Alisa Pierce
Reporter, Division of Communications and Marketing
(512) 370-1469