A health insurance giant is trying to show physicians and policymakers that it’s serious about reducing the impact of prior authorization reviews on providers and patients.
UnitedHealth Group’s UnitedHealthcare unit has posted a list of procedure codes for about 1,700 procedures that will no longer be subject to routine prior authorization review requirements.
The simpler items on the list include biopsies of the insides of people’s noses, the outsides of people’s ears, and nerves.
The other items on the list include many procedures related to colonoscopies, problems with the esophagus, eye operations and reproductive organ imaging.
The prior authorization changes take effect Oct. 1.
UnitedHealthcare posted a separate announcement indicating that it will stop requiring advance notification for capsule endoscopies, diagnostic colonoscopies, surveillance colonoscopies and efforts to scope out the esophagus and stomach starting Oct. 1.
UnitedHealthcare is also trying to make its physician prior authorization portal easier for physicians to use.
What it means: For employers and benefits advisors, the change may mean that employers will hear fewer complaints about requests for coverage for procedures being denied and hear fewer complaints from physicians they know about spending half an hour trying to explain treatment plans to health insurance company and health plan administrator representatives.
But the changes could also mean that plan participants will be more likely to get overly expensive or unnecessary care, and that a few more plan participants will get care that will harm them.
For some of the people who have been working on health insurers’ and plan administrators’ utilization management teams, the changes may lead to loss of employment.
The backdrop: Dr. Mehmet Oz, the current administrator of the Centers for Medicare & Medicaid Services, said at his confirmation hearing that one of his top goals was to reduce the number of medical procedures subject to prior authorization requirements. Since then, health insurers have been talking about efforts to eliminate the need for new federal prior authorization laws and regulations by voluntarily reducing the scope of prior authorization requirements.
In April, UnitedHealthcare said it was eliminating prior authorization requirements for most procedures for about 1,500 rural hospitals and their affiliated physicians by this fall.
In June, the company said it would try to reduce prior authorization requirements for procedures for children by two-thirds by the end of this year.