Starting June 1, Coloradans who have United Healthcare will need approval for medical procedures using a scope in their digestive systems — a move that could either curb inappropriate care or discourage patients from getting what they need.
Insurers like it as a way to reduce the amount of care that’s unnecessary or even harmful — which they argue saves everyone money — while doctors and hospitals see it as a time-suck that keeps patients from getting treatments they need.
Dr. Larry Kim, a partner in South Denver Gastroenterology, said he doesn’t understand why United Healthcare chose to add prior authorization requirements for procedures that use scopes in the esophagus, stomach and the upper part of the small intestine, as well as colonoscopies that are meant to diagnose or treat a problem in the large intestine.
While most patients will eventually get care, he said, they may spend additional days coping with bleeding or pain while the authorization goes through.A representative for United Healthcare said scope procedures are overused, however, and that raises costs and places patients at unnecessary risk. While scope procedures are relatively safe, there’s a small chance of injury, infection or complications from anesthesia.
“Multiple clinical studies have shown significant overutilization or unnecessary use of non-screening gastroenterology endoscopy procedures, which may expose our members to unnecessary medical risks and additional out-of-pocket costs,” the company said in a statement.
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