Insurance
UnitedHealth audit reviews how insurer develops medical policies
The audit found few problems in how UnitedHealthcare develops medical policies, but did not examine how the criteria are used to approve or deny care.
UnitedHealth Group released an independent review of how its insurance unit, UnitedHealthcare, develops medical policies used in coverage decisions. FTI Consulting and Rubrum Advising reviewed the expertise and processes of the more than 80-person policy team and a sample of nine policies. They found the team well-staffed and qualified, and the sample policies evidence-based and well-researched. The review identified a lack of explicit documentation about when to create a policy and how to vet subject matter experts.
The reviewers did not assess the specific content of the policies or how UnitedHealthcare applies them when deciding whether to approve or deny care. They also did not examine potential cost considerations. Healthcare Dive reported that more than 48 million people are covered by the company’s insurance plans. CEO Stephen Hemsley said UnitedHealth would use the findings to strengthen its processes, and the company said it would continue the audits.
