UnitedHealthcare to Remove Nearly Two-Thirds of Pediatric Prior Authorization Requirements by Year-End

UnitedHealthcare said it plans to eliminate close to two-thirds of prior authorization requirements for healthcare services involving members under age 18 by the end of the year, with the changes applying across its commercial and Medicaid plans.

The insurer announced Friday that it will remove prior authorization requirements for a range of pediatric healthcare services, including diagnostic tests, routine surgeries and specialty care services. The changes will affect pediatric subspecialties including cardiology, neurology, pulmonology, and orthopedics, according to the company.

UnitedHealthcare said it will eliminate prior approval requirements for many diagnostic services, routine surgical procedures, and specialty care involving children as part of a broader effort to review pediatric healthcare approvals. The company said it is assessing which prior authorization requirements can be removed while maintaining safety and quality standards.

According to the insurer, the review includes all pediatric prior authorization requirements and is being conducted through what it described as a rigorous, data-driven process. The company said the goal is to determine which services can safely proceed without advance approval requirements.

The insurer said prior authorization requirements will be removed for some diagnostic imaging, sleep studies, routine outpatient tests, and selected therapies and surgical services that are consistently approved. At the same time, UnitedHealthcare said prior authorization will continue for healthcare services involving high clinical complexity or variability. These include experimental treatments and cases where approvals are required under regulations.

The company also announced authorization waivers for certain procedures performed at leading pediatric hospitals. UnitedHealthcare said the facilities included in the program represent a broad national network across medical and surgical specialties. According to the insurer, the waivers reflect what it described as the hospitals’ consistent use of well-established care practices.

“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,” said Tim Noel, CEO of UnitedHealthcare.

Noel added that the changes are part of broader efforts by the company to simplify healthcare processes and reduce administrative requirements for families, doctors, and nurses seeking routine care, while higher-risk procedures will continue to be reviewed.

UnitedHealthcare said the latest move follows other recent steps aimed at reducing prior authorization requirements. Last month, the company announced that rural healthcare providers would be exempt from most prior authorization requirements.

The insurer has also worked to reduce reauthorization requirements at its pharmacy benefit manager, Optum Rx. In a separate announcement made last month, UnitedHealth and CVS Health said they had standardized data and submission requirements for more than half of their prior authorizations.

The company said that by the end of the year, more than 70% of UnitedHealthcare’s prior authorizations will be included in a new standardized submission process. UnitedHealthcare also said insurers have been working to follow commitments made last year to reduce excessive paperwork tied to prior authorization requirements that can delay or deny needed care.

UnitedHealthcare has announced plans to eliminate nearly two-thirds of its pediatric prior authorization requirements by the end of the year. The decision by UnitedHealthcare is expected to simplify healthcare access for children, reduce delays in treatment, and ease administrative responsibilities for healthcare providers.

The move reflects UnitedHealthcare’s ongoing efforts to improve the healthcare experience for patients, families, and clinicians while promoting more efficient care delivery.

UnitedHealthcare Streamlines Pediatric Care Access

Prior authorization requirements are commonly used by health insurers to review certain medical services before approval. While these processes are intended to ensure appropriate care, they can sometimes create delays for patients and additional paperwork for healthcare providers.

By reducing these requirements, UnitedHealthcare aims to make it easier for pediatric patients to receive necessary medical services without unnecessary administrative barriers. The initiative is expected to improve the overall healthcare experience for families seeking timely care.