Industry Voices—How UHC's new prior authorization policy for colonoscopies could make patients wait

Imagine you have severe abdominal pain and blood in your stool. Thinking the worst, you rush to your doctor—only to find that your insurance company is dragging its feet in approving the care you need.

As a result, you must wait to have an endoscopic exam that can diagnose what’s wrong and put you on the path to treatment.

As shocking as this sounds, this will be the reality for all UnitedHealthcare members starting on June 1. That’s because UHC will begin enforcing new, restrictive prior authorization requirements for critical, time-sensitive colonoscopies and endoscopies. This confounding decision will disrupt, delay, and deny patients’ access to the diagnostic and surveillance procedures that help improve outcomes and save lives.

UnitedHealthcare is among the largest health insurance providers in the country. I am also concerned that if this is not reversed, other insurers will follow suit.

With patients and physicians preparing for the worst, UHC must immediately rescind this misguided and burdensome new requirement to ensure access to proper gastrointestinal (GI) care for millions of Americans.

UHC’s new prior authorization requirements target critical GI services that help physicians catch and diagnose life-threatening diseases like colorectal cancer earlier, giving patients a better chance of survival, as well as procedures that are necessary to monitor disease progression in patients. With patient adherence already being a cause of concern in the GI community, this policy could have detrimental and far-reaching consequences for Americans’ health outcomes.

By forcing patients to get prior authorization, I worry that UHC’s policy could deter patients from undergoing or following up on their medically recommended procedures; intensify existing socio-demographic disparities in care and outcomes; and create new, onerous administrative burdens for physicians.

That is particularly true for surveillance colonoscopies, which are recommended for patients with a history of colon polyps or colon cancer or who have undergone prior procedures to remove or treat these conditions. Studies show exceedingly low adherence to follow-up surveillance colonoscopies after polyp removal and colorectal cancer resection. Since colorectal cancer is the fourth leading cause of cancer-related deaths in the U.S., screening and surveillance are critical to saving lives.

We must do everything possible to increase adherence, yet insurance barriers like prior authorization will have the complete opposite effect. These new, burdensome requirements will only further exacerbate this problem, which is most prevalent among the highest-risk, most vulnerable patient groups. For patients from low-income and marginalized communities, it is already challenging enough to take off work, arrange childcare, and secure transportation to medical appointments. Any disruption caused by prior authorization could literally mean the difference between getting screened or not.

Even before this new policy was announced, 95% of gastroenterologists said that insurers’ prior authorization restrictions had impacted patient access to clinically appropriate treatments. Unfortunately, insurance companies’ interference with medical decision-making is not limited to our specialty; it is a widespread and pervasive problem across the healthcare system. A survey by the American Medical Association found that one-third of physicians report that prior authorization policies have led to a serious, adverse event for a patient in their care, while one in four report that such policies have led to a patient’s hospitalization. Moreover, 94% of physicians say prior authorization delays access to necessary care for patients whose treatments require it.

Access to care has been very challenging since the pandemic began. Much care has been delayed and patients are, sicker than ever. Putting up barriers to access is the opposite of what we should do together to get our population healthy!

Time is running out for UHC to reverse its decision to implement onerous new prior authorization restrictions on life-changing and life-saving GI procedures that millions of Americans rely on to maintain optimal health. Failure to do so will result in unnecessary and potentially harmful or even fatal delays and denials of care for at-risk patients. With UHC recently announcing it would scale back prior authorization requirements for a wide range of procedures and devices, we call on the company to remove barriers to endoscopies and colonoscopies.

There is no medical rationale for implementing prior authorization for these critical procedures, the vast majority of which will be approved eventually. Insurers are not medical doctors and should not force physicians to prove their treatment decisions are correct for established treatment plans that save lives. UHC should immediately rescind this policy change and recommit itself to curbing its use of abusive prior authorization policies that delay access to care.

I call on all of you, no matter whether you are a doctor or a patient, to raise your voice.  We are all affected by this policy.

Barbara Jung, M.D., is the president of the American Gastroenterological Association.