UnitedHealthcare outpatient surgery policy threatens hospital revenue

UnitedHealthcare outpatient surgery policy threatens hospital revenue

UnitedHealthcare is ramping up a prior authorization policy intended to shift outpatient surgeries to lower-cost settings outside of the hospital, a move that could put a dent in hospital revenue.

It’s the latest volley in a battle over where care should be delivered. Other health insurers in recent years have begun refusing to pay for some services, such as MRIs, when they occur in hospitals, which generally charge higher prices than physician offi ces or ambulatory surgery centers. UnitedHealthcare’s new policy takes an aggressive stance on planned surgeries.

“This policy really shifts the burden to the patient and the physician to prove that a hospital site is warranted, and what is distressing is that it’s adding another level of complexity to an already complicated system of pre-authorization,” said Lyndean Brick, president and CEO of healthcare consultancy Advis.

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by Shelby Livingston on 10/17/19 at 12:39 PM EDT