UnitedHealthcare to Eliminate Prior Authorization for Select Services
"Parents should be able to spend less time having to navigate the health system and more time focusing on their children as they get the care they need."
— Tim Noel, CEO of UnitedHealthcare
UnitedHealthcare has announced two separate initiatives to eliminate prior authorization requirements for certain medical services. One initiative covers selected services for the general population, and the other covers a larger proportion of pediatric services for members under 18.
Changes for General Population
UnitedHealthcare stated that by the end of 2026, it will remove prior authorization requirements for approximately 30% of the medical services that currently require this approval.
The affected services include:
- Select outpatient surgeries
- Some diagnostic tests (such as echocardiograms)
- Some outpatient therapies
- Some chiropractic care
The company will publish the complete list at UHCProvider.com before the change takes effect.
The company noted that prior authorization applies to 2% of all medical services it covers, and 92% of those requests are approved within 24 hours.
Changes for Pediatric Services
Separately, UnitedHealthcare announced it will eliminate prior authorization requirements for approximately two-thirds of healthcare services for members under 18.
This change covers many areas, including:
- Diagnostic services
- Routine surgical procedures
- Specialty care in cardiology, neurology, pulmonology, and orthopedics
The insurer stated it will introduce authorization waivers for certain procedures performed at select comprehensive pediatric hospitals. The company reported it is conducting a data-driven review of all pediatric prior authorization requirements to determine which services can be safely removed.
Industry Context and Standardization Efforts
Prior authorization has been a subject of criticism from medical professionals. The American Medical Association has reported that physician offices spend an average of 12 hours per week seeking approvals. Some patients have reported experiencing delays or denials of treatment.
In response to these pressures, a group of insurers represented by America's Health Insurance Plans (AHIP) stated last year that several major members—including Blue Cross Blue Shield of California, Humana, Kaiser Permanente, and UnitedHealthcare—would take steps to streamline the prior authorization process.
UnitedHealthcare also noted that last month, UnitedHealth and CVS Health standardized data and submission requirements for more than half of their prior authorizations. The company said more than 70% of its prior authorizations will be part of this new standardized submission process by the end of the year.