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UnitedHealthcare Suspends Imaging Prior Authorization Requirements

Effective April 1, 2020, UnitedHealthcare (UHC) had 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.

On June 23, the AANS, the CNS and the and the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves (DSPN), sent a letter to UnitedHealthcare (UHC) expressing opposition to a new policy for the surgical treatment of spinal conditions. 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 convened a conference call with UHC leadership to discuss our concerns about this policy.

Responding to the AANS, CNS and DSPN, 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 organized neurosurgery’s letter. He assured the neurosurgical groups 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.” However, in select cases, UHC “may require images when necessary to determine if clinical criteria are met.”

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