UnitedHealthcare Suspends Imaging Prior Authorization Requirements for Spine Surgery
Effective April 1, 2020, UnitedHealthcare (UHC) issued Medical Record Requirements for Pre-Service Reviews requiring surgical practices to upload radiographic studies via a web-based portal as a condition of obtaining prior authorization for the surgical treatment of spine pain and total artificial disc replacement. To further clarify this policy, UHC also issued Medical Policy Documentation Requirement Updates frequently asked questions.
Following complaints from neurosurgeons across the country, the American Association of Neurological Surgeons (AANS), Congress of Neurological Surgeons (CNS) and AANS/CNS Section on Disorders of the Spine and Peripheral Nerves (Spine Section) sent a letter to UHC. The letter stated that the new policy “is unnecessary, ill-advised and will adversely affect patients’ timely access to care.” The groups further pointed out that “the policy inappropriately veers towards the practice of medicine” and asked UHC “to permanently end this new policy.” In addition to the letter, representatives from the AANS, CNS and the American Academy of Orthopaedic Surgeons (AAOS) convened a conference call with UHC leadership to discuss our concerns about this policy.
Responding to the AANS, CNS and Spine Section, Russell H. Amundson, MD, FAANS, a neurosurgeon and senior medical director for UHC, acknowledged that physicians, practice administrators and others had raised similar concerns to those outlined in our letter. He assured us that UHC was evaluating and refining its “administrative processes to address and resolve the issues identified.” Dr. Amundson also noted that the health plan was “suspending denials on initial review for lack of information/lack of required images,” although in select cases (not defined), UHC “may require images when necessary to determine if clinical criteria are met.”
Despite the suspension of the policy, neurosurgeons report that UHC continues to require images as a condition of prior authorization. AANS/CNS Washington Office staff are working with UHC to help ensure that the health plan is not, at this time, routinely requiring neurosurgeons to submit images for spine-related procedures. We are also working with UHC on broader prior authorization relief and value-based care programs, particularly to leverage neurosurgeon participation in the American Spine Registry, a collaborative effort between the AANS and the AAOS.
In the meantime, if UHC continues requiring you or your practice to submit images for the spine procedures identified in its policy, please email us the de-identified details at email@example.com. AANS/CNS Washington Office staff will compile and share this information with UHC.