New Prior-Authorization Requirements for UnitedHealthcare Medicare Advantage: Involve Your Patients!
Updated 9/6/2024 – This article was updated on 9/6/2024 to remove references to Humana. During our advocacy efforts, Humana informed the ICS that the chiropractic preauthorization requirements for their Medicare Advantage plans only apply to doctors located in Southern Florida and Southern California. Now, Humana has removed the references to chiropractic in their “preauthorization list summary of changes” document, and the primary “PAL” document now reflects the geographic specifics. Illinois doctors do not have to perform preauthorization for Humana Medicare Advantage Plans. Here is a link to the full update article.
**Important Note: Below is a link to a flyer to provide your UHC Medicare Advantage patients. This will provide the information they need to call their insurers to request the elimination of prior authorization for chiropractic care. **
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We want to bring to your attention significant changes in prior authorization requirements that will impact your practice and some of your Medicare Advantage patients. UnitedHealthcare (Optum) implemented these changes on September 1, 2024. As your professional association, the Illinois Chiropractic Society (ICS) has been actively advocating on your behalf, and we want to ensure you are fully informed and prepared for these upcoming changes.
What Are the Changes?
UnitedHealthcare (through its Optum subsidiary) now requires prior authorization for chiropractic and other therapy services under Medicare Advantage plans.
UnitedHealthcare (Optum) announced providers must obtain approval for defined treatment plans (request a number of visits). This policy will apply to chiropractic manipulative therapy (CMT), physical therapy, occupational therapy, and other related services, excluding the initial evaluation. Although UHC initially stated the program would apply to “multi-disciplinary offices,” the updated version indicates that it could apply to all chiropractic practices.
This new requirement imposes an additional administrative burden on providers and could significantly delay patient care, particularly for Medicare Advantage patients, who have chosen these plans expecting streamlined access to conservative care options.
What Is ICS Doing for You?
The Illinois Chiropractic Society is fully aware of the challenges these changes will bring to your practice and your patients. In response, ICS has taken proactive steps to oppose these new requirements:
- Advocacy Efforts: We sent a formal letter to Mr. Tim Noel, the CEO of the UHC Medicare division, outlining our strong opposition to the prior authorization requirements. In this letter, we highlighted the unjustified burden this will place on providers and patients alike, the potential delays in care, and the adverse impact on patient health, particularly in underserved areas.
- Collaboration: ICS is not alone in this fight. We are working closely with national associations, such as ChiroCongress and other state chiropractic associations, to build a united front against these prior authorization requirements. Our collective voice amplifies the concerns of chiropractic physicians across the nation and seeks to protect our patients’ access to timely, effective care.
How Can You Utilize the Patient Advocacy Flyer?
We have developed a patient advocacy flyer that you can distribute to your patients. The flyer details the impact of these new requirements and empowers them to take action. It provides clear instructions for your patients on how to contact UnitedHealthcare directly. It encourages them to demand respect for the treatment plans you recommend and to urge their insurers to stop the prior authorization requirement for chiropractic and other physical therapy care.
What the Flyer Says:
- Patients are urged to call UnitedHealthcare and voice their concerns.
- Key points include requesting insurers to respect the physician-recommended treatment plans without unnecessary delays, avoid barriers to care, and halt the prior authorization process altogether.
We believe that informed and empowered patients can make a difference by voicing their concerns directly to their insurance providers. Please consider sharing this flyer with your patients as part of your ongoing communication efforts.
Moving Forward
As the effective dates of these prior authorization changes approach, ICS will continue to monitor the situation closely and keep you informed of any new developments. We are committed to advocating on your behalf and ensuring that chiropractic care remains accessible to all patients, especially those who rely on Medicare Advantage plans.
Thank you for your continued dedication to providing high-quality care to your patients. We encourage you to reach out to ICS with any concerns or questions about these changes and to stay engaged with our advocacy efforts.
