While payers may be making some positive changes to prior authorization requirements when it comes to Medicare Advantage, some insurance providers are still throwing up speed bumps to expeditious musculoskeletal care.
As of April 1 and July 1, United Healthcare (UHC) has made the following updates to both its commercial benefit plans and its Individual Exchange benefit plans that add additional requirements for PTs, OTs, and SLPs:
- Initial authorization for therapy must also include a plan of care (POC) signed and dated by a referring provider or authorized specialist. The POC must include:
- Functional or physical impairment;
- Short and long-term therapeutic goals and objectives; and
- Treatment, frequency, duration, and expected length of treatment sessions.
- All treatment session notes must have start and stop times for treatment in the documentation.
What can patients do?
The requirement for a POC with initial authorization could hamper patients’ ability to seek out treatment from rehab therapists at the prescribed frequency and duration. To that end, the APTA is recommending that providers tell their patients adversely affected to file a grievance with UHC stating that their access to care has been compromised.
Depending upon the type of plan, here is where patients should direct their correspondence:
APTA also has template letters for patients to send to payers to their employers or legislators that request intervention on their behalf in reversing these policies.
What can rehab therapists do?
Providers can also advocate for policy changes through the APTA’s members-only State Payer Advocacy Resource Center (SPARC), which includes resources focused on prior authorization.
Furthermore, they can stay apprised of changes from UHC by subscribing to their newsletter in their resource library.
Rehab therapists treating patients insured by UHC are going to have to jump through additional hoops in order to stay compliant and get paid—not ideal at a time when provider workloads are heavier than ever. Fortunately, there are avenues for both rehab therapists and patients to make their voices heard with UHC in the hopes that they’ll roll back the policy and stop adding roadblocks to treatment.