UnitedHealthcare Group, the largest health insurance company in the U.S. by market share, made several significant healthcare moves in 2023. Here are the five most impactful updates:
- Prior Authorization Cuts: UnitedHealthcare initiated two waves of cuts to its prior authorization requirements. The first wave, starting on September 1, eliminated 20% of its current requirements. The second wave in November included cuts to community plans.
- Changes in Medicare Advantage Plans: The company is discontinuing some Medicare Advantage plans and exiting certain service areas for 2024. This includes some plans co-branded with AARP, UnitedHealthcare MedicareDirect, some dual-eligible plans, and other Medicare Advantage options. Despite these changes, UnitedHealthcare is expanding its overall Medicare Advantage offerings for 2024.
- Revamped Prior Authorization Policy for Gastroenterology and Endoscopy: After receiving pushback from medical groups, UnitedHealthcare revised its planned prior authorization policy changes for gastroenterology and endoscopy. Initially set to implement new policies on June 1, the insurer faced criticism that the changes would limit access to necessary care and add burdens to physicians. The revised policy, focusing on advance notification for non-screening and nonemergent GI procedures, also faced criticism for potentially limiting patient access to lifesaving procedures.
- Enhancements to UCard Benefits: UnitedHealthcare plans to enhance the benefits of its UCard, an integrated insurance ID card. The UCard, used by Medicare Advantage and D-SNP members, serves as a traditional insurance ID card and offers additional functionalities like paying for healthy food, over-the-counter products, utilities, and gym check-ins. In 2024, the company aims to expand its Medicare Advantage plans to cover 96% of Medicare-eligible individuals.
- Lawsuit Involving Prisma Health: UnitedHealthcare faced a lawsuit from Greenville, S.C.-based Prisma Health, alleging breach of contract. Prisma Health accused UnitedHealthcare of disclosing information about its rate proposals to media outlets and not providing copies of statements to the media 48 hours before publication. UnitedHealthcare denied the breach, stating that Prisma Health had coordinated a media effort to pressure the insurance company amid contract negotiations.
These updates reflect UnitedHealthcare’s ongoing adjustments and challenges in the dynamic healthcare insurance market.