UnitedHealth to cut 66% of pediatric prior authorizations by year-end

UnitedHealthcare will eliminate roughly two-thirds of prior authorization requirements for members under 18, the latest push by the largest U.S. insurer to reduce administrative hurdles that doctors say delay care.

UnitedHealthcare will eliminate roughly two-thirds of prior authorization requirements for pediatric members by year-end, the insurer said May 29, as the industry moves to cut administrative red tape that doctors and patients have long criticized.

"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, chief executive officer of UnitedHealthcare, said in a statement.

The changes cover diagnostic services, routine surgical procedures and specialty care across pediatric subspecialties including cardiology, neurology, pulmonology and orthopedics. UnitedHealthcare will also introduce authorization waivers for certain procedures performed at leading comprehensive pediatric hospitals, reflecting their "consistent use of well-established care practices," the insurer said. The policy applies to both commercial and Medicaid plans, which cover millions of children across the country.

The move is part of a broader industry push. Large insurers including UnitedHealthcare, Blue Cross Blue Shield, Cigna, Kaiser Permanente and Humana have vowed to reduce prior authorization use after years of complaints from physicians and patients that the process routinely delays or denies care. UnitedHealthcare previously committed to eliminating prior approval requirements for 30% of health care services across all ages by the end of 2026.

Insurers Cut 11% of Prior Auths Under Reform Pledge

The industry has made measurable progress. Insurers have eliminated 11% of prior authorization requirements under a reform pledge made last year, according to industry data. UnitedHealthcare said it is conducting a data-driven review of all pediatric prior authorization requirements to determine which services can be safely removed. Prior authorization will remain in place for services with high clinical complexity or variability, such as experimental treatments, or where required by regulations.

The company has also taken other steps to streamline the process. Last month, UnitedHealth said it would exempt rural providers from most prior authorization requirements. At its pharmacy benefit manager Optum Rx, the company has reduced reauthorizations for more than 40% of drugs. More than 70% of UnitedHealthcare's prior authorizations will be part of a new standardized submission process by the end of the year, the insurer said.

Balancing Access With Cost Control

For UnitedHealth Group, the parent company of the largest U.S. health insurer, the policy shift carries both risks and potential rewards. Reducing prior authorization could lower administrative costs for providers, potentially making UnitedHealthcare plans more attractive to employer clients and increasing membership. However, removing pre-approval requirements may also lead to higher utilization costs, which could pressure the company's medical loss ratio — the share of premium dollars spent on medical claims.

The broader industry is watching closely. If UnitedHealthcare's pediatric policy succeeds in maintaining quality while reducing administrative burden, it could pressure other major insurers to adopt similar changes, reshaping how managed care operates across the sector. The last time the industry faced similar pressure to streamline prior authorization was during the Covid-19 pandemic, when many insurers temporarily waived requirements for certain services to ease hospital strain.

This article is for informational purposes only and does not constitute investment advice.