In June, UnitedHealthcare introduced a new advanced notification system for patients undergoing specific procedures like esophagogastroduodenoscopies, capsule endoscopies, diagnostic colonoscopies, and surveillance colonoscopies. Although gastroenterologists were pleased that the initially proposed prior authorization rules were not implemented, many still expressed reservations and skepticism about the advanced notification and gold carding process.
Dr. Benjamin Levy, a gastroenterologist at the University of Chicago Medicine, stated that while the advanced notification system is preferable to prior authorization, there are still concerns about potential delays in diagnosing cancer in patients with alarming symptoms and general medical management. The medical community was relieved when the proposed prior authorization requirements were switched to advanced notification.
However, the advanced notification process adds administrative tasks for physicians and gastroenterology practices, diverting their attention from providing prompt care. Gastroenterologists aim to offer the best and most efficient care for their patients. Changes in prior authorization can lead to:
- Delays in care.
- Some patients possibly forgoing crucial colonoscopy procedures due to authorization challenges.
- A rise in the need for extra medical staff to handle administrative demands.
Gastroenterologists are keen to understand more about the previously mentioned gold card program and its potential to remove prior authorization requirements. There’s a concern that those who don’t participate in UnitedHealthcare’s ‘advance notification’ might not qualify for the gold card program, resulting in more administrative tasks and care delays.
Gastroenterologists hope that UnitedHealthcare will collaborate with major gastroenterology associations like the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy to enhance the provision of gastroenterology care and seek their feedback.