UnitedHealthcare12月1日起取消2000多项儿童医疗事先授权：耳管、扁桃体与核磁等不再预审
美国最大健康保险公司之一 UnitedHealthcare 11月2日宣布，自12月1日起，其承保的18岁以下儿童在接受2000多项儿科医疗服务时，将不再需要事先授权（prior authorization）。公司当天公布了不再需要预审的2000多个 CPT 医疗服务代码的完整清单，供医疗机构提前准备。
取消预审的服务涵盖常见诊疗、诊断影像、睡眠研究、癌症治疗与骨科护理，具体例子包括耳管置入与扁桃体手术、睡眠研究、核磁共振（MRI）与CT扫描、关节手术、心脏手术，以及部分肿瘤与化疗服务。UnitedHealthcare 表示，入选的都是医学界普遍认为安全有效的服务，此举将使儿科事先授权总量减少近三分之二，医生、家庭与照护者可以把更多时间放在患儿身上。
「每个孩子都应该得到以其需求为中心的医疗体验，」UnitedHealthcare 首席执行官 Tim Noel 说，「这些改变将让孩子、他们的家庭以及照顾他们的医生，获得更简单的体验。」
少数复杂服务仍需事先授权，包括某些注射药物、基因检测、部分外科手术，以及州法规要求管理的项目。部分儿科服务仍需事先通知（advance notification）。此次调整适用于 UnitedHealthcare 商业保险计划、个人交易所计划与社区计划（以州法允许为限），且不限于在特定儿科机构接受的治疗；医疗机构可通过 UnitedHealthcare 医疗机构门户的授权与通知工具，查询具体服务、会员与计划的最新要求。
这一公布兑现了该公司今年5月的承诺：到年底前取消近三分之二的儿科事先授权要求。公司表示，这也是其简化事先授权整体工作的一部分，包括已把事先授权总量减少约30%、扩大对遵循循证指南的医疗机构群体的「金卡」计划等。
（据 UnitedHealthcare 通过 Business Wire 发布的新闻稿）
UnitedHealthcare to Drop Prior Authorization for More Than 2,000 Pediatric Services Starting December 1
UnitedHealthcare announced on November 2 that, beginning December 1, children covered by its plans will no longer need prior authorization for more than 2,000 pediatric care services. The company published the full list of more than 2,000 distinct CPT codes that will no longer require prior authorization for patients under age 18, giving care providers the information to prepare for the changes.
The services span common care, diagnostic imaging, sleep studies, cancer treatment and orthopedic care. Examples include ear tube and tonsil procedures, sleep studies, MRI and CT scans, joint procedures, cardiac procedures, and some oncology and chemotherapy services. UnitedHealthcare said it fast-tracked services widely considered in the medical community to be safe and effective, resulting in a nearly two-thirds reduction in pediatric prior authorization volume, so clinicians, families and caregivers can spend more time focused on patients.
"Every child deserves a health care experience centered on their needs," said Tim Noel, CEO of UnitedHealthcare. "These changes will help make that experience simpler for children, their families and the physicians who care for them."
Select complex services will still require prior authorization, such as certain injectable medications, genetic tests, some surgical procedures, and services required to be managed by state regulations, and some pediatric services will continue to require advance notification. The changes apply to UnitedHealthcare commercial plans, UnitedHealthcare Individual Exchange Plans and UnitedHealthcare Community Plans, where permissible by state law, and are not limited to care delivered at specific pediatric facilities.
The publication follows the company's May commitment to eliminate nearly two-thirds of pediatric prior authorization requirements by the end of the year. UnitedHealthcare said the step builds on broader efforts to simplify prior authorization, including reducing total prior authorization volume by approximately 30 percent and expanding its Gold Card program for provider groups that consistently adhere to evidence-based care guidelines.
(Source: UnitedHealthcare press release via Business Wire)
来源：GSM·美国（原文链接）
图片来源：图：儿科医生为女童看诊讲解（资料图）。Nenad Stojković 摄，CC BY 2.0，经 Wikimedia Commons。 / Photo: A pediatrician consulting with a young patient (file photo). Photo by Nenad Stojković, CC BY 2.0, via Wikimedia Commons.
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