Unitedhealth Group To Let Physicians Decide Treatments - Brief Article - Statistical Data Included

Healthcare Financial Management, Dec, 1999

UnitedHealth Group Inc., Minneapolis, Minnesota, plans to let physicians have the final say on medical treatments for their patients, even if the insurer's staff thinks the treatments are medically unnecessary. The decision reverses a prevailing managed care practice of requiring preauthorizations for virtually all medical treatment.

UnitedHealth Group, which insures 14.5 million people in the country, found that medical reviews of physicians' treatments resulted in higher costs for the insurer. United-Health Group has reduced its medical monitoring staff by 20 percent as a result of the new policy, which will enable the company to save $25 million of the $100 million it spends yearly on medical reviews. Under the new policy, physicians still must notify the insurer if their patients enter the hospital, require home health care, or need expensive medical equipment, and the insurer's staff may suggest less-costly treatments, but the final decision on medical necessity will rest with the treating physician. The insurer said its decision was not influenced by recent lawsuits against health insurers for denial of coverage.