UnitedHealthcare is launching a national gold-card program, and leaders of spine and orthopedic organizations are thinking about the benefits and potential drawbacks of it.
Gold card practices that stick to evidence-based guidelines will be able bypass prior authorizations for some cases under the program.
Leaders with the International Society for the Advancement of Spine Surgery, the North American Spine Society, and the American Academy of Orthopaedic Surgeons shared their perspectives on the program.
Note: Responses were lightly edited for clarity.
Morgan Lorio, MD. ISASS president (2024-2025): UnitedHealthcare's gold-card program, which eliminates prior authorizations for 20% of codes, may seem like progress, but its impact is limited. While reducing prior authorizations is a step forward, one wonders why these particular 20% of codes were chosen instead of offering more comprehensive relief for all services. The bulk of the administrative burden remains, leaving 80% of services still entangled in red tape. This approach risks creating confusion without delivering substantial reform. While the program doesn't add new burdens, it fails to significantly reduce the existing ones, making it more about optics than meaningful change. Comprehensive reform is still needed to address the real issues facing providers.
As I've observed regarding insurance carriers, I would like to think that this is about the patient, but I fear it remains all about the bottom line—a token gesture rather than a real solution to the real issues facing spine surgeons.
Zoher Ghogawala, MD. president of NASS: I believe that improvements in the efficiency of obtaining pre-authorization is important for spine care. The United Gold Card Program represents a first step in improving the efficiency of the process. Ultimately, the success or failure of these programs should be based on patient outcome. If we can demonstrate that the gold card program reduces delays and improves outcomes, that will be a great step forward for American spine care.
Adam Bruggeman, MD. Chair of the AAOS Advocacy Council: This is a big step in the right direction. I appreciate that the efforts of medical and patient organizations have shown how prior authorizations have become over utilized and harmed patients in the process. The success of the program will depend on how United carries out the details of who qualifies, which will undoubtedly be in their favor. We will also need to keep a close eye on post procedure clawbacks as prior authorization processes are dialed back.