Prior Auth for Colonoscopy Will Put Patients at Risk, Says ACG’s Dayna Early

In this video, Dayna Early, MD, chair of the American College of Gastroenterology (ACG) Board of Governors, discusses UnitedHealthcare’s new policy requiring prior authorization for surveillance and diagnostic colonoscopies, which is set to go into effect on June 1.

Early explains how this new policy could be detrimental to patients requiring immediate care, and what healthcare providers can do to help. Early is a professor of medicine and director of endoscopy at Washington University in St. Louis.

The following is a transcript of her remarks:

Announced this spring, UnitedHealthcare — at the same time as announcing that they were going to reduce the burden of prior authorization in general — stated that they were going to have a new policy starting June 1st, that nearly all endoscopy procedures would require prior authorization before they would be willing to cover them.

This new rule applies to all upper endoscopy procedures, and it applies to diagnostic and surveillance colonoscopy so really, the only group of general GI procedures that’s exempted is screening colonoscopy. So this new rule is going to apply to a significant number of patients.

The biggest way this change can impact patients is that it’s going to cause a delay in their care. We know that sometimes when there’s delay in care, a patient’s ability to participate in the healthcare process, and enthusiasm for having their follow-up procedures, may become more difficult, and so we really like to capture patients in the moment when the doctor has recommended a particular procedure, and be able to schedule that procedure in real time.

Having to do prior authorization will require staff members to either make phone calls or enter a computer portal in order to gain prior authorization, and this can cause delays. And no one really knows how long the delay will be with UnitedHealthcare. They’ve stated that it’ll be a 2-day delay, but we have no degree of certainty that that’s going to be the case.

What’s really disappointing is that by including diagnostic and surveillance colonoscopy and upper endoscopy, they’re basically targeting the group of patients that actually have symptoms or abnormalities and are at highest risk of having an abnormality found on the upper endoscopy. These are really the patients that shouldn’t be delayed, that should have their procedure in a timely fashion.

[UnitedHealthcare] really seems sort of deaf to our concerns that we have expressed in the meetings that we’ve had with them.

As far as the work the ACG is doing to combat this, we’ve had two meetings with UnitedHealthcare expressing our concern about the barriers this is going to pose to patients. One of the meetings was a meeting of three different GI societies, including the ACG, with UnitedHealthcare. We were told we could have a follow-up meeting, and they’ve now rescinded that offer.

We have created a letter that we have sent to state insurance commissioners making them aware of this new policy; we have sent out multiple member alerts to our members, encouraging them to contact their legislators and their state health commissioners, and we’re going to develop a flier of sorts to post in our offices so that patients are aware that this is a policy that UnitedHealthcare has put in place.

Healthcare providers can help their patients by informing them about this new change, helping them understand what it means, and assuring them that our office staff will be doing everything they can to get the prior authorization in a timely fashion.