UnitedHealthcare’s new policy will require doctors and patients to get authorization before common procedures including some colonoscopies and scopes of the throat, stomach and digestive tract.
LaTesha Harrison needs one or two scopes of her digestive system every year so her doctor can track her complications from Crohn’s disease.
But the suburban Baltimore woman worries these necessary procedures will soon be delayed, even when she feels bloated, aches or can’t eat. Beginning June 1, her health insurer, UnitedHealthcare, will require doctors and patients to get authorization before common procedures including some colonoscopies and scopes of the throat, stomach and digestive tract.
“If I have to wait one, two or three weeks, that can land me in the hospital and the emergency room and that’s costly to me,” said Harrison, who works as a nurse at Baltimore-area hospital. “I have a job. I’m a mother. I can’t take (time) off and go to the emergency room just to get a scope so my doctor can see if I need to be on a certain type of medication to help me through my flare.
Doctors specializing in digestive issues are writing letters, pressuring executives and posting on social media in a campaign to halt the new policy being implemented by UnitedHealthcare, one of the nation’s largest health insurers.
The controversy is the latest example of how doctors and medical organizations are fighting insurers’ efforts to implement “prior authorizations,” which require an insurer’s consent before they agree to pay for certain prescriptions, medical services or treatments.
Health insurers say these reviews are needed to limit unnecessary medical services, reduce potential harms and make sure consumers don’t pay for care they don’t need.
But doctor groups say these policies delay care, harm patients and create unnecessary paperwork that contribute to higher administrative costs. Patients might choose to skip care or be forced to pick up a larger share of their health spending, they argue.