The California Medical Association (CMA) has submitted a letter in strong opposition to UnitedHealthcare’s recently announced policy requiring prior authorization for certain gastroenterology endoscopy services for commercial plan members effective June 1, 2023. CMA is concerned that this new policy is yet another unnecessary, administrative burden that will simply delay patient access to medically necessary diagnostic services.

Included in the new prior authorization requirements are the following procedures:

• Esophagogastroduodenoscopies
• Capsule endoscopies
• Diagnostic colonoscopies
• Surveillance colonoscopies

(Screening colonoscopy procedures are not included in this new prior authorization requirement. Additionally, this policy does not apply to GI endoscopy services provided in an emergency room, urgent care center observation unit or inpatient setting.)

This policy change came on the heels of a contradictory announcement by UnitedHealthcare that announced the payor’s plans to reduce prior authorizations across the board by 20%.

CMA believes that if UnitedHealthcare’s goal is to control costs and overutilization, targeted provider education will prove to be more effective and less costly for all in the long term.

For more information about this policy, see UnitedHealthcare’s FAQ, “Prior authorization for gastroenterology endoscopy services.” Questions or concerns about this policy can be directed to UHC Provider Services at (866) 416-6594.

Share Your Prior Authorization Stories

When insurance companies get between patients and physicians, patients get sicker and health care becomes more expensive. CMA is sponsoring legislation to reform the prior authorization process, which will result in less time spent on administrative work, increased access to necessary care for patients and a restoration of the physician-patient relationship in medical decision-making.

CMA is encouraging physicians whose practices and patients have been negatively impacted by prior authorization to share their stories. By adding your voice to the call for prior authorization reform, you can help ensure that patients receive the care they need — when they need it.