Overview
- UnitedHealthcare, which announced the change Friday, said it will eliminate roughly two-thirds of prior authorization rules for members under 18 by the end of the year.
- Prior authorization is the insurer review that can delay care, and the company said the cuts will cover many diagnostic tests, routine outpatient surgeries and specialty pediatric services in cardiology, neurology, pulmonology and orthopedics.
- The policy applies to the insurer’s commercial and Medicaid plans and also creates authorization waivers for certain procedures at leading comprehensive pediatric hospitals, though the company did not name the facilities.
- UnitedHealthcare will still require pre-approval for clinically complex or variable care such as experimental treatments and specialty drugs and it plans to move more than 70% of authorizations into a standardized submission process by year-end.
- The move follows industry vows last year to reduce paperwork and could speed routine care and cut administrative costs for parents and clinicians, but implementation details and the exact services removed remain to be disclosed.