VIDEO: ACG ‘remains skeptical’ of UHC’s Gold Card benefits; GI practices have final say
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In a Healio video exclusive, members of the ACG Board of Governors voiced concerns over the potential impact of UnitedHealthcare’s national Gold Card program for gastrointestinal procedures following its launch on Oct. 1, 2024.
“The ACG remains skeptical about the benefits of the Gold Card program, but individual practices really need to ultimately decide what’s best for their patients and their staff,” Dayna Early, MD, FACG, chair of the ACG Board of Governors, professor of medicine at the Washington University in St. Louis and director of endoscopy at Barnes Jewish Hospital, told Healio.
Although UHC’s Gold Card program list includes 30 gastroenterology-related imaging codes that may be “beneficial” for practices with a large population of UHC-insured patients, Early noted that the reduction in administrative burden is unclear since advanced notifications are still required, even if prior authorization is not.
“Gold card programs are poised to be nothing more than the next generation of these failed prior authorization protocols,” she added.
Echoing these sentiments, Jay N. Yepuri, MD, MS, FACG, ACG Governor for Northern Texas and physician executive at the Digestive Health Associates of Texas, added that UHC’s program “deserves further scrutiny and attention,” specifically on whether eligibility will be based on services or codes used.
Yepuri noted that other gold card programs have been used in Texas since 2021. However, at most, 3% of providers in the state have received a gold card, which he attributed to a lack of “clear and consistent communication from insurers” on gold card eligibility status, further fragmenting an already overly bureaucratic process.
“Gold card programs are designed to make it easier for our staff and patients to access care, but so far this hasn’t been the case in Texas,” he said. “With regards to gastroenterology, I have yet to hear a scenario where a patient’s treatment wasn’t subjected to prior authorization process because a GI provider had a gold card.”
Reference:
- UnitedHealthcare National Gold Card Program: GI-related CPT code list. Available at: https://webfiles.gi.org/docs/policy/UHC-GoldCard-GICodeSummary.pdf. Accessed: Sept. 30, 2024.
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