UnitedHealthcare said May 29 it would cut by two-thirds the pre-approval requirements for Children’s, which the health insurance giant covers, by the end of 2026.
What’s changing for kids
UnitedHealthcare said prior authorizations include certain diagnostic services, routine surgical procedures and specialty care such as cardiology, neurology, pulmonology and orthopedics.
UnitedHealthcare also said it would implement “authorization waivers” for certain procedures at some pediatric hospitals. These waivers will be based on children’s hospitals’ “continued use of well-established care practices,” UnitedHealthcare said in a news release.
Although UnitedHealthcare did not name the hospitals that would be eligible for such discounts, the insurer said the hospitals are part of an “extensive network of nationally recognized pediatric centers spanning medical and surgical specialties.”
The insurer said it will eliminate pre-approval requirements for other pediatric services such as some diagnostic imaging, sleep studies and routine non-hospital testing. UnitedHealthcare will maintain pre-approval requirements for complex care and experimental treatments.
Changes to the reviews for child care will apply to people who are covered by UnitedHealthcare’s private insurance and Medicaid, the federal-state health care program for low-income families and people with certain disabilities.
part of a broader push
The move targeting red tape for doctors and families amid complaints of administrative delays or denial of care to people is part of the insurer’s goal announced May 5 to eliminate pre-approval requirements for 30% of health care services.
Doctors and patients have long criticized prior authorizations, in which an insurer reviews a request before billing doctors or other medical providers for health care services or prescriptions. Doctors say administrative actions routinely delay or deny care.
Big insurers such as UnitedHealthcare, Blue Cross Blue Shield, Cigna, Kaiser Permanente and Humana have vowed to reduce the use of prior authorizations.
As part of its previously announced effort to reduce administrative barriers for patients of all ages, UnitedHealthcare has vowed to cut prior authorizations on certain outpatient operations, diagnostic tests such as echocardiograms, outpatient therapy and chiropractic care by the end of 2026.
USA TODAY Network via Reuters Connect