In the world of prior authorization reforms, an insurance “gold card” may sound like a golden ticket. But some providers say the shine wears off fast.
This program, offered by UnitedHealthcare and states like Arkansas and Texas, allows providers with a track record of approved prior authorizations to bypass some of the process’s hurdles. And there are a lot of hurdles. Prior authorizations take up an average of 13 hours of a physician’s week, according to a 2024 American Medical Association (AMA) survey.
A Sept. 4 press release from United claims a 40% increase in the number of provider groups qualifying this year compared to the year before, though United didn’t provide Healthcare Brew with the actual number.
But despite the program’s growth, gold cards don’t seem to be making a huge impact. Only 3% of providers in Texas qualified for the state’s gold card in December 2024, according to the Texas Department of Insurance. And an AMA survey published in August 2024 found just 8% of 1,000 physicians contracted with health plans that offered programs like gold cards.
“It’s a simple, elegant concept,” Kavita Nair, professor of neurology and pharmacy at the University of Colorado Anschutz Medical Campus, told Healthcare Brew. “Lots of the appeal gets lost in the actual operationalization.”
Card caveats. UnitedHealthcare’s program requires provider groups to have been in network for the last two consecutive years and have done at least 10 eligible prior authorizations annually with an approval rate of 92% for both years to get gold card status for a medical code.
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Those who qualify submit an advance notification for a procedure through the same online portal, phone system, or fax process they would otherwise use to submit a prior authorization request. Unlike prior authorization, it doesn’t require clinical information. They then receive notification that no additional information is needed, according to a United FAQ page.
United said in its press release that 94% of the “most active gold card users” it surveyed said they’re satisfied overall and the program has reduced administrative tasks. United did not provide the number surveyed.
But to Nair, it feels like a “bait and switch” that gold card providers still have to submit a request through a portal before doing a procedure.
“You’re still making folks go through hoops. You’re just saying ‘We’re not asking for additional clinical documentation,’” Nair said. “I guess we’ll take any steps that we don’t have to do, but it’s not creating the kind of meaningful impact that it could create.”
It’s also hard for independent groups to measure the exact impact these prior authorization reforms have, Kaye Pestaina, director of patient and consumer protection for the nonpartisan health policy research organization KFF, told us.
“We always have a barrier in terms of getting access to prior authorization data for commercial insurance,” Pestaina said.