United Launches National ‘Gold Card’ Program
By Phil West

UnitedHealthcare (UHC) announced the launch of what it’s calling a national “gold card” program, which purports to allow physicians to bypass the prior authorization process and is set to begin Oct. 1. 

The Texas Medical Association is analyzing the interaction between the national program and Texas’ gold card program, which have differing standards. As of this writing, TMA had yet to see guidance from United on how it plans to implement its national program in Texas alongside the state’s gold card program.  

The move comes on the heels of testimony by TMA Council on Legislation Chair Zeke Silva, MD, to the House Committee on Insurance on Sept. 5, in which he emphasized Texas’ current prior authorization system – including holding payers accountable under House Bill 3459 – is still in need of additional reform. 

“Given the extensive burdens and inefficiencies prior authorizations cause, comprehensive reform is essential,” he said in prepared statements. “Additionally, there is a need for greater transparency in payer policies and the establishment of evidence-based guidelines to ensure prior authorization requirements are applied consistently and fairly.”  

UHC calls its new gold card system the first of its kind, saying on its website the program “simplifies the prior authorization process for qualifying providers and eligible services.” It requires physicians “to submit advance notification, which confirms eligibility and network status, but no clinical information will be requested.” 

Per its website, eligibility requirements include:  

• Being in network for at least one UHC health plan;  

• Meeting a minimum annual volume of at least 10 eligible prior authorizations each year for two consecutive years across UHC’s gold card-eligible codes; and 

• Having a prior authorization approval rate of 92% or more across all UHC’s gold card-eligible codes for each of the review years.  

TMA Director of Public Affairs Ben Wright says while UHC’s attempt to address prior authorization burdens is encouraging, asking physicians for advanced or early notification of a service is reminiscent of a pilot program the insurer rolled out last year, which TMA criticized.  

“They're calling it the same thing [as a gold card program], but it has very different standards [than Texas’ law]. It's going to be implemented a different way on a different timeline, targeting only specific services,” he said.   

Mr. Wright characterized the UHC plan as differing from legislative efforts that led to passage of Texas’ prior authorization exemption law, TMA-backed HB 3459, authored by Rep. Greg Bonnen, MD (R-Friendswood).  

HB 3459 established that for state-regulated plans, Texas physicians could earn a continuous exemption from prior authorization by earning approvals on at least 90% of their preauthorizations on a given service over a six-month period. The law set a trend of gold card legislation that other states have followed. 

United acknowledges on its website that state gold card programs – including Texas’ – “may differ from our National Gold Card program.” 

The Texas Department of Insurance reported in March 2023 that only 3% of physicians and health care professionals had received gold cards.  

Physicians contacting TMA remain puzzled by the process of securing exemptions from payers, even though Texas’ law has been in effect for nearly two years, reports TMA Physician Payment Services Director Carra Benson.  

“They could call payers five times and get five different answers,” she said of some physicians’ experiences in getting exemptions.  

Ms. Benson oversees TMA’s Physician Payment Resource Center, through which she said TMA “work[s] as that bridge between the physician and the health plan on getting to the right person to get them a true answer.”  

Visit the center for assistance with insurance payment-related issues. And for more information and resources, visit TMA’s insurance webpage.