Effective Sept. 1, UnitedHealthcare will begin requiring prior authorization for physical therapy services performed in multidisciplinary offices and outpatient hospital settings.
As many as 9 in 10 physicians say prior authorization has a negative effect on patient outcomes, with authorizations either always, often or sometimes delaying patients' accessing necessary care in 94% of cases, according to a recent American Medical Association survey.
Physical therapy and orthopedic professionals have expressed concern over UnitedHealthcare's plan to add more prior authorization requirements at the start of the month.
"I believe it is shameful that UHC, after announcing a gold card program meant to reduce the burden of prior authorizations, has now turned around and implemented an increase in prior authorization requirements," John DeLucchi, a physical therapist at Charlotte-based OrthoCarolina, told Becker's. "More unnecessary layers of bureaucracy that hinder patient care. Forcing practitioners to jump through hoops just to deliver the treatment patients need not only slows down the process but also undermines the trust and value we strive to build with our patients. This policy shift feels like a step backwards for patient care."
Beginning Oct. 1, UnitedHealthcare plans to launch a national gold-card program that aims to reduce prior authorization burdens for some procedure codes. While some physicians are optimistic about the program, the insurer continues to add prior authorization requirements for certain specialties, including PT, occupational therapy, speech therapy and Medicare-covered chiropractic services.
"Following a member's initial consultation and evaluation, we are asking certain therapy providers to provide information to confirm that treatment plans are supported by appropriate clinical evidence and continue to align with the member's current health needs," a spokesperson for UnitedHealthcare told Becker's.
UnitedHealthcare emphasized that clinical reviews of prior authorization requests are conducted by appropriately licensed, same-specialty medical professionals, including physical therapists, occupational therapists, speech-language pathologists and chiropractors.
Additionally, review of the treatment plan is not necessary until after the physical therapist's initial evaluation, ensuring patients have access to care and the treating physician has the information they need to develop a treatment plan that aligns with clinical evidence, the spokesperson said.