Physician Referral Policy Changes

Physician Referral Policy Changes

On a trip to New York, I enjoyed spending some time with the medical director of United Healthcare, the nation’s second largest health insurer.  He explained that they were spending $100 million annually on the administrative costs of the referral approval process, where administrative staff members decide whether a physician’s referral of a patient to a specialist is medically necessary.

While this tedious ordeal did identify up to $30 million annually of ‘unnecessary’ referrals to specialists, on balance it didn’t save any money.  It did, however, create headaches and delays for patients, their physicians, and the insurance company.  I applaud United Healthcare’s new decision to give physicians the decision-making authority to make the referrals their patients need.  What a healthy step forward.

Dr. Greene is the founder of (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

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