UnitedHealthcare Cuts Two-Thirds Pediatric Prior Authorization Under Unitedhealthcare Pediatric Prior Authorization
Unitedhealthcare pediatric prior authorization will be eliminated for about two-thirds of UnitedHealthcare's healthcare services for members under age 18, the insurer said Friday, May 29. The change covers many diagnostic services, routine surgical procedures and specialty care services, and it points parents toward less time spent on paperwork and more time on care.
Tim Noel said, "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," putting the operational goal in plain terms. For families using the plan, the shift should mean fewer pre-visit approvals across a large share of pediatric care.
UnitedHealthcare Pediatric Services
About two-thirds is the scale of the change, and it reaches pediatric subspecialties including cardiology, neurology, pulmonology and orthopedics. UnitedHealthcare also said it will introduce authorization waivers for certain procedures performed at leading comprehensive pediatric hospitals, narrowing one of the most time-consuming steps in the care process for children who need specialty treatment.
Many diagnostic services and routine surgical procedures are part of the reduced approval list, which means the insurer is targeting both testing and treatment, not just one corner of pediatric care. That breadth matters for parents moving between specialists, because the policy applies to members under age 18 rather than a narrower group within the plan.
Tim Noel and Prior Approvals
More than half of UnitedHealth and CVS Health's prior authorizations were standardized last month, and UnitedHealthcare said more than 70% of its prior authorizations will be part of the new standardized submission process by the year's end. The company said it is conducting a rigorous, data-driven review of all pediatric prior authorization requirements to determine which services can be safely removed.
The pressure point is still the remaining portion of care that will keep its approval rules, especially where the insurer has not said which pediatric services stay in the process. Families and providers now have a clearer path on a large share of care, but the review leaves the rest of the pediatric prior authorization system in place while the company expands the standardized process through the year's end.
