UnitedHealthCare plans to put colonoscopies behind a consent procedure

“When gastroenterologists learned in March that UnitedHealthcare plans to barricade many colonoscopies behind a controversial and complicated process known as prior authorization, their emotions cycled rapidly between fear, shock, and outrage,” Angus Chen writes over at Stat. ‘The change, which the health insurer will implement on June 1, means that any United member seeking surveillance and diagnostic colonoscopies to detect cancer will first need approval from United — or else have to pay out of pocket. ‘It was stunning,’ said Dayna Early, a gastroenterologist at Washington University in St. Louis and chair of the American College of Gastroenterology’s board of governors. ‘It applies to everything we do except screening colonoscopy’ — routine procedures meant to detect cancer in low-risk, healthy members of the general population between the ages of 45 and 74. ‘One of the most frustrating things is we don’t understand why they are doing this.’ Physicians say that requiring prior authorization will make it more difficult for patients to get endoscopic procedures, particularly cancer diagnostic and surveillance procedures, in a timely fashion. These make up roughly half of the procedures that gastroenterologists perform. UnitedHealthcare has said that prior authorizations in general should be completed within two days, but clinicians interviewed by STAT said that’s rarely the case. ‘People with concerning symptoms for cancer, suddenly they may have to wait potentially weeks or months or longer for this to get approved,’ said Folasade May, a gastroenterologist at the University of California, Los Angeles. ‘It may not even get approved. ‘For those patients who have undiagnosed cancer, a months-long delay in diagnosis can be disastrous, May said. Some colorectal cancers can be slow-growing, but others can be fatally aggressive without early intervention. ‘I don’t want to see colorectal cancer patients saying, “I started seeing symptoms 10 months ago, but I had to get prior auth, and now I have stage 4 disease,”’” she said.” Angus Chen, “Stunning change to United’s colonoscopy coverage roils physicians and patients,” Stat. Related: “How much does a colonoscopy cost? $600 or $16,000?” on our blog.