UnitedHealthcare to require prior authorization for colonoscopy

UnitedHealthcare will start requiring prior authorization for non-screening colonoscopies, upper GI endoscopies, and capsule endoscopy procedures beginning on June 1, 2023. There are several good reasons a health insurance company may require prior authorization before covering certain medical procedures. The company wants to ensure it is medically necessary and makes financial sense. At the same time, however, companies should use prior authorization judiciously as it can delay necessary treatment or cause patients to abandon the procedure altogether.

There is, however, absolutely no good reason for UnitedHealthcare to require prior approval for a colonoscopy. The medical benefits and frequency of colonoscopies are well-established and should not be questioned by insurers. For “high-risk” patients, such as those who previously had polyps removed or have a family history of colorectal cancer, the U.S. Preventive Services Task Force recommends that service is required to be covered. Yet UnitedHealthcare plans to make patients wait anyway, even though they are deemed high risk and the medical benefit is not in question.

Can this decision by United Healthcare harm patients? Absolutely. In a survey by the American Medical Association, 34% of physicians reported that prior authorization led to a serious adverse event, and 80% reported that the prior authorization process can lead to treatment abandonment.

On March 29, UnitedHealthcare announced plans to cut back on using prior authorization by 20%. 

“We will continue to evaluate prior authorization codes and look for opportunities to limit or remove them while improving our systems and infrastructure,” said Anne Docimo, Chief Medical Officer. 

Why then, at the same time, is UnitedHealthcare adding a requirement for colonoscopies when the frequency and benefits are not at issue? Furthermore, the timing of this decision, which came during National Colorectal Cancer Awareness Month, suggests the company is out of touch with our community.

The Colorectal Cancer Alliance has joined with Fight CRC and other patient groups in opposing this decision and is calling on UnitedHealthcare not to implement the change as planned. If you are insured by UnitedHealthcare, please join us in challenging this unnecessary and potentially dangerous decision. Please send an email to Andrew Witty, Chief Executive Officer for United Health Group, at Andrew.witty@uhg.com.