Earlier this spring, UnitedHealthcare (United) announced plans to effectively use prior authorizations as blockades to colonoscopies. Any patient seeking a surveillance or diagnostic colonoscopy to detect cancer would first need approval from the insurer, otherwise they would have to pay out of pocket. Gastroenterologists everywhere were outraged.
Practitioners were most worried about the dangers that prior authorizations posed to patients’ health. Without early intervention, colorectal cancer can be life-threateningly aggressive. Even a months-long delay for a colorectal cancer screening can be fatal. What’s worse – United made its announcement in March, which just so happens to be Colorectal Cancer Awareness Month. Talk about insensitive.
But the night before the policy was supposed to take effect on June 1, United backed down.
What they came up with isn’t much better.
Instead of requiring patients to seek prior authorizations, United’s new policy will require physicians to collect and submit patient data before performing certain kinds of screenings, according to Fierce Healthcare.
United refers to this process as “advance notification.” We refer to it as “major inconvenience.”
It will result in a burdensome amount of paperwork for physicians who are already floundering in administrative hassles and red tape brought on by insurers.
The hassles are ostensibly meant to prevent overutilization – in other words, patients receiving medical procedures they don’t need. But according to Barbara H. Jung, M.D., president of the American Gastroenterological Association (AGA), the about-face indicates the insurer doesn’t have any data that would support its efforts to make care more difficult to access.
As far as United’s part, they claim that it’s all in the name of good health. A spokesperson from United discussed the risk of overutilization of colonoscopies, including “unnecessary medical risks and additional out of pocket costs.”
But actually, between March and April 2020, colorectal cancer screening (CRC) decreased by 85 percent in the United States. Even before the pandemic, between 2018 and 2020, the U.S. saw a 16 percent decrease in colonoscopies.
But even if colonoscopies were on the rise, let’s rethink our priorities, United. The bigger risk isn’t unneeded colonoscopies, but undetected cancer. The longer a patient delays a colorectal cancer screening, the greater the chance for the cancer to spread.
Regardless of the motivations of the nation’s largest commercial health insurer, it bears repeating that insurers have no business making medical decisions. And by making doctors jump through even more hoops of paperwork to prove that their patients need a procedure, insurers are wasting practitioners’ precious time and patients’ money – both of which are in short supply.
