A meeting between officials with UnitedHealthcare and the physician organizations whose members might be most affected by the insurer's controversial new prior authorization policy for colonoscopies ended without much satisfaction for either side, according to the doctors.
UHC officials did offer to delay the launch of the policy, which is scheduled for this Thursday. But that didn’t satisfy members of the American Society for Gastrointestinal Endoscopy, the American College of Gastroenterology and the American Gastroenterological Association, who met with the health plan representatives last Friday.
“UHC’s stated purpose of [the] meeting was to discuss delaying their GI prior authorization program in exchange for an ‘advance notification program’, requiring GI practices and staff to gather detailed patient data prior to procedures and in preparation for a Gold Card program in 2024,” the GI societies said in a joint press release. “Unfortunately, what UHC verbally presented in our meeting was a poorly defined and complicated administrative process. The GI societies are not in a position to appropriately evaluate the UHC proposal with the limited information presented.”
UnitedHealthcare is the largest commercial health plan in the U.S. A spokesperson for Aetna told Fierce Healthcare in an email that “Aetna does not require prior authorization for colonoscopies. We continue to cover screening colonoscopies under the preventive benefit at no cost share to the member. We are not re-visiting these policies at this time.”
UHC told Fierce Healthcare recently that “we are asking physicians to follow the guidelines and evidence-based practices developed by their own gastroenterology medical societies to help ensure our members have timely access to safe and clinically appropriate care. The physicians who will be most affected by this new policy are those who are not already following these evidence-based practices, which again, were developed by gastroenterology-related medical societies.”
Of concern to the GI societies is the fact that younger people are contracting colon cancer. Colonoscopies become part of preventive care for not-at-risk groups starting at age 50, although that was changed to age 45 in 2021.
Just why younger people seem to be getting the disease remains somewhat of a mystery. Research scheduled to be presented at the annual meeting of the American Society of Clinical Oncology next month posits that the microbiome of young adults, the pathogens that people carry in their guts, might be the cause. The research has not yet been peer reviewed.
Lead author Benjamin Weinberg, M.D., of the Lombardi Comprehensive Cancer Center in Georgetown University, called the proposed prior authorization changes “wrong” in an email to Fierce Healthcare.
“We’re trying to figure out what younger individuals (under 45) who are still too young to generally get screening colonoscopies are getting colorectal cancer (mostly rectal and near-rectal colon cancers) at increasing rates since the mid-1990s,” Weinberg said. “I’m not advocating necessarily lowering the colonoscopy screening age to below 45 for those at normal risk, but clearly the consensus guidelines recommend screening colonoscopies at least by age 45 if not earlier in all patients, thus it’s frustrating that insurance companies would place further roadblocks in front of an effective screening test that both finds early-stage colon cancers that don’t require treatment beyond surgery and also removes pre-malignant polyps prior to them becoming invasive cancers.”