#StopUHC campaign calls on insurer to rethink looming ‘Gold card program’ for GI endoscopy
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As part of its ongoing campaign against UnitedHealthcare and the insurer’s plans to implement the Gold Card program for gastrointestinal endoscopy procedures, AGA encourages all supporters to use the hashtag #StopUHC on social media.
“We need to keep the pressure on UHC by sharing how bad prior authorization is for patients. AGA wants to hear from our members when insurance companies put up barriers to care,” Barbara Jung, MD, AGAF, AGA past president and chair of the department of medicine at the University of Washington, told Healio. “Many of these issues take place at the local and state level, but the value of a national organization like ours is that we can help locally while also advocating for change nationally.”
#StopUHC: Rally through social media
In partnership with Schmidt Public Affairs, AGA launched the #StopUHC social media campaign in early 2023, utilizing the “David vs. Goliath” effect against UHC after the company announced plans to start a prior authorization policy for GI endoscopy procedures — a move that would have affected more than 27 million of its beneficiaries.
For its efforts, AGA in May received an Anvil Award of Excellence in public affairs from the Public Relations Society of America.
Following the widespread backlash from AGA and more than 4,500 gastroenterologists and patients, UHC on June 1, 2023, announced it would postpone its plans to implement the prior authorization policy, the day the policy was to go into effect. Instead, the insurer implemented an advance notification process “for non-screening gastroenterology procedures,” which applies to its commercial plans and requires physicians to collect and submit patient data before performing colonoscopies and endoscopies.
The fight continues
When UHC rolled out the advanced notification program, it was in “preparation for a prior authorization Gold Card program in 2024,” Jung noted, which would allow adherent physician groups to skip prior authorization for certain procedures. However, physicians remain skeptical of the insurer’s intentions and how this alternative program could impact patient access, especially as AGA in a statement from December 2023 noted UHC plans to implement a prior authorization on “virtually all endoscopy and colonoscopy services.”
Since UHC’s announcement last year, AGA has continued its fight to have this program repealed. The organization is working with legislators in Washington to demand transparency from UHC and reform their intent to implement the policy. AGA also supports the Improving Seniors’ Timely Access to Care Act, “which will put important safeguards in place around prior authorization in Medicare Advantage and increase insurer transparency,” Jung said.
In addition, Rep. Donald Payne Jr. gave a speech in July 2023 denouncing the company and their policy. Other legislators to speak against the policy include Rep. Mark Green (R-TN) and Sen. Elizabeth Warren (D-MA).
Lack of transparency ‘unreasonable’
To further raise awareness about UHC’s plans, AGA had asked members to write to media outlets explaining how the policy would hurt patients and practices. Authors include Jung; Maria T. Abreu, MD, AGAF, AGA’s current president; Folasade P. May, MD, PhD, MPhil, DEI editor for the organization’s journal, Clinical Gastroenterology and Hepatology; and Lawrence Kim, MD, AGAF, AGA president-elect, among others.
Jung again urged UHC to reconsider the program in the AGA statement from December, with concerns that included transparency, lack of details and the burden it will inflict on practices. Further, she noted it would significantly impact patient care by causing delays or patients ending their care.
“Prior authorization is bad for patients made to wait for care and bad for doctors whose offices are buried in administrative paperwork,” Jung told Healio. “Reforming prior authorization is a high priority for AGA.”
Despite AGA efforts, UHC has yet to respond.
“After many requests, they unfortunately haven’t provided AGA with any additional information,” Jung said. “It is hard to predict what’s coming without more information. The lack of transparency is unreasonable.”
References:
- Advance notification for gastroenterology endoscopy services: Frequently asked questions. https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/Prior-Auth-Gastroenterology-FAQ.pdf. Accessed May 29, 2024.
- AGA campaign to block UHC's GI prior auth policy. https://gastro.org/advocacy-and-policy/policies-affecting-gi/aga-campaign-to-block-unitedhealthcare-gi-prior-auth-policy/. Accessed May 29, 2024.
- PRSA Anvil Awards Ceremony. https://www.prsa.org/docs/default-source/conference-and-awards/anvil-awards-documents/prsa-2024-anvil-online-program.pdf?sfvrsn=c75102b4_2. Accessed May 29, 2024.
- UHC’s promise to impose prior authorization for virtually all colonoscopies and endoscopies in ‘early 2024’ puts critical care in limbo for its 27 million commercial beneficiaries. https://gastro.org/press-releases/uhcs-promise-to-impose-prior-authorization-for-virtually-all-colonoscopies-and-endoscopies-in-early-2024-puts-critical-care-in-limbo-for-its-27-million-commercial-beneficiar/ Published Dec. 20, 2023. Accessed May 29, 2024.
- UnitedHealthcare: Gastroenterology endoscopy advance notification. https://www.uhcprovider.com/en/prior-auth-advance-notification/gastroenterology-prior-auth.html. Accessed May 29, 2024.
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