New Requirements for Gastroenterology Services
Beginning June 1, 2023, prior authorization for certain gastroenterology endoscopy services for UnitedHealthcare plan members. Please note that screening colonoscopy procedures are not included in this new medical necessity requirement review. The following procedures will now require prior authorizations:
- Esophagogastroduodenoscopies (EGD)
- Capsule endoscopies
- Diagnostic colonoscopies
- Surveillance colonoscopies
Providers can obtain prior authorization by using the Prior Authorization and Notification tool on UHCprovider.com or by calling 866.889.8054. Prior authorizations are valid for 90 calendar days from the date it is issued.
Out-of-pocket Costs Eliminated for 24/7 Virtual Visits for Eligible Members
Beginning with fully insured plans renewing July 1, 2023, UnitedHealthcare will eliminate out-of-pocket costs for 24/7 Virtual Visits offering plan participants an option to access care for nonemergency medical issues that may be more affordable and convenient. Employers with self-funded plans may adopt a similar policy for their employees. Additional fully insured plans will gain access starting in 2024.
Eliminating out-of-pocket expenses for 24/7 Virtual Visits may help reduce the burden of medical costs for consumers and encourage earlier interventions, which can reduce the risk of complications and avoid visits to costlier settings such as the emergency room. The coverage enhancement will apply to most fully insured health plans with and without a health savings account (HSA) through at least the end of plan year 2024, as allowed by current federal regulations.
With 24/7 Virtual Visits, members can connect on demand to a doctor by phone or video through myuhc.com® or the UnitedHealthcare app, including national care providers such as Optum Virtual Care. Doctors can treat a wide range of health conditions, from flu and pinkeye to migraines and more, and may prescribe medication as needed. 24/7 Virtual Visits may treat many of the same conditions as an ER or urgent care, offering a more convenient and affordable alternative — particularly at night or on weekends when many primary care providers are usually unavailable.