Health insurance giant UnitedHealthcare said on May 5 it would eliminate pre-approval requirements for 30% of health care services amid complaints of administrative delays or denial of care to people.
The Minnesota-based insurer is one of several large insurers that have vowed to reduce the use of “prior authorizations” to review requests before doctors or other medical providers bill them for health care services or prescriptions. Doctors and patients have long criticized prior authorizations, with surveys and government oversight reports saying the practice routinely delays or denies care.
UnitedHealthcare said it would expire prior authorizations on certain outpatient operations, diagnostic tests such as echocardiograms, outpatient therapy and chiropractic care by the end of 2026. The insurer said prior authorizations are used about 2% of medical services covered by UnitedHealthcare, and when requests are submitted, 92% are approved in less than a day.
In a statement, UnitedHealthcare CEO Tim Noel said the move will make it easier for patients to get care and allow doctors to spend more time with patients.
“We are committed to further improving and refining our processes to make reviews faster, simpler and more efficient,” Noel said.
A comprehensive industry incentive
In June, UnitedHealthcare, Blue Cross Blue Shield, Cigna, Kaiser Permanente, Humana and other insurers joined with Trump administration health officials in announcing they would cut and streamline the use of prior authorizations. Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services Administrator Mehmet Oz said insurers have promised to make such changes voluntarily.
But Oz said the federal government could adopt rules and regulations to enforce changes if insurers don’t make promised reforms.
Insurers said the changes would apply to 257 million Americans covered by private commercial insurance, Medicare Advantage and Medicaid managed care plans.
In March, UnitedHealthcare announced it would publicly report data on prior authorizations and post the data on the company’s website.
Doctor vs Insurer
Doctors complain that prior authorization is burdensome and is often used to delay or deny medically necessary medical care to patients. In an American Medical Association survey of 1,000 physicians, 93% of doctors reported that prior authorization delayed care for patients.
Insurance companies counter that the authorization is a vital tool to prevent unnecessary tests and medical care that drive up medical bills for families. Consumers often have to pay a portion of medical bills through an insurance plan co-payment, co-insurance or deductible – the amount a person must pay before insurance coverage begins.