Industry Voices—UnitedHealthcare's Advance Notification program is getting in the way of patient care

Insurance policies are notoriously known for red tape and processes that burden both doctors and patients. As a gastroenterologist at Capital Digestive Care, a private practice in Washington D.C., Maryland, and Virginia, I have dealt with this regularly.

But now, UnitedHealthcare (UHC)—one of the largest health insurers in the country—intends to create even more barriers to timely, critical treatment for patients facing gastrointestinal (GI) health concerns here in the nation’s capital and across the country.

UHC first came under fire earlier this summer when it tried to institute highly restrictive prior authorization requirements on most colonoscopies and upper endoscopies which are common procedures. Prior authorization requires physicians to “prove” the treatment plan they recommend to patients is warranted—an egregious intrusion into medical decision-making by non-medical professionals. Ironically, UHC’s announcement regarding this move came on the heels of an earlier statement that the insurer would be working to curb burdensome prior authorization policies that delay patients’ access to care.

Facing immediate backlash from the GI community, patients, and lawmakers, UHC instead replaced its initial proposal with an ill-defined and poorly rolled out “Advance Notification” program. However, it does not take much digging to realize that this program is merely a stepping-stone to the company’s future implementation of prior authorization.

The Advance Notification program requires GI providers and practices to collect and input highly granular data for each patient before being able to order most colonoscopy and endoscopy procedures. UHC claims the data will be used to help inform the creation of a “Gold Card” prior authorization program that will be introduced sometime in 2024.

The Advance Notification program has already been an administrative nightmare, creating hours of additional work to complete the program’s burdensome reporting requirements. In my practice, it takes 10 minutes on average to process UHC’s Advance Notification requests. When multiplied by the thousands of patients who come to us for care, this amounts to 335 hours per month submitting paperwork ONLY for procedures for UHC patients.

This results in a disproportionate administrative burden and takes away valuable time and labor from providing patient care. Ultimately, it requires an inordinate number of additional staff members to be hired and trained to process these insurance forms, which will only be used to “justify” prior authorization. This is on top of all the other burdensome prior authorizations and peer-to-peer discussions we already have to obtain from every other insurance carrier for medications, procedures, and radiologic tests our patients require.

In short, Advance Notification is not only a tremendous waste of resources and time, but it also detracts from the sole mission of any physician practice: to deliver high-quality, timely care. Insurance barriers like this are why two-thirds of physicians feel burnt out, and roughly 20% of doctors plan to leave practice within two years.

As a gastroenterologist, I am trained to diagnose and treat various digestive diseases as well as prevent and diagnose cancer. Being a medical provider also means advocating for my patients’ best interests. Policies like UHC’s fail to put patients’ health first and act as a barrier between doctors and their patients.

Patients deserve timely access to care and treatment. If UHC continues as planned, the regulatory and administrative hurdles for patients will only get higher and harder to clear in 2024, when the “Gold Card” program is expected to roll out. Prior authorization for these GI services will have detrimental consequences and delay timely access to care, worsening patient outcomes. Allowing for disease progression that will risk the very lives of our patients.

The time-sensitive GI procedures that UHC is targeting with prior authorization are critical in helping to detect, treat, and monitor a range of diseases that impact millions of Americans, including colorectal cancer, esophageal and gastric cancer, Crohn’s disease, and ulcerative colitis, among many others. Colonoscopies and endoscopies are not only medically necessary, but they are routine and the standard of care. There is no good reason to require additional red tape or prior authorization for them and UHC has provided no data to show that these procedures are over-utilized.

It is past time to protect patient access to timely care. UHC needs to retract this deeply flawed Advance Notification program and work with the GI community to achieve their originally stated intent of reducing—not increasing—barriers to care.


Jessica D. Korman, M.D. is a gastroenterologist at Capital Digestive Care in the Washington, D.C. area, Medical Director of the Endoscopy Center of Washington DC, and a member of the Education and Training Committee of the American Gastroenterological Association