Credit: Jodi Jacobson/iStock
UnitedHealthcare told providers earlier this week that it will no longer require them to get permission in advance to seek reimbursement for 231 procedures.
"This change is part of our comprehensive effort to simplify the health care experience for our members and network health care professionals," the UnitedHealth subsidiary said in an announcement about its new prior authorization rules.
The change affects employers that use UnitedHealthcare commercial plans as well as individual patients who buy UnitedHealthcare coverage from HealthCare.gov or another Affordable Care Act public health insurance exchange.
The move affects 196 nuclear medicine procedures, 18 obstetrical ultrasound procedures and 17 electrocardiography procedures.
Twenty-eight of procedures involve imaging of thyroid and parathyroid glands, 20 involve lungs and four involve the hearts of fetuses.
The change will not affect other procedures UnitedHealthcare might use to discourage unnecessary use of imaging procedures.
What it means: Employers might be happy to hear that health plan participants will face fewer obstacles to getting necessary, high-value care.
But employers and their plan administrators continue to face pressure to reduce spending on unnecessary care and low-value care. They might like to hear about other ideas for holding down spending on imaging.
The backdrop: The UnitedHealthcare announcement about the list of procedures subject to prior authorization reviews comes as health insurers are facing resistance from health care providers, patients and some policymakers in Washington and state capitals over concerns that doctors often waste hours explaining the need for routine or obviously necessary procedures to health plan administrators who know little about the procedures.
Dr. Mehmet Oz, a cardiothoracic surgeon and the current administrator of the Centers for Medicare and Medicaid Services, said during his confirmation hearing in March that prior authorization reviews are a big headache for providers and that one solution might be to limit the number of procedures subject to prior authorization reviews.
UnitedHealthcare's parent company, UnitedHealth, promised regulators that it would try to reduce the prior authorization burden.
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.