UnitedHealthcare vows to cut down use of prior reviews for kids’ care
UnitedHealthcare said May 29 that the health insurance giant will cut by two-thirds its pre-approval requirements for children it covers by the end of 2026.
Some diagnostic services, routine surgical procedures and specialty care services such as cardiology, neurology, pulmonology and orthopedics will also be reduced or cut, among previous furloughs that UnitedHealthcare has noted.
The move, which targets red tape for doctors and families, is part of a goal the insurer announced May 5 to eliminate pre-approval requirements for 30% of health care services amid complaints that administrative tasks delay or deny people care.
Doctors and patients long criticized prior authorizationsAn insurer reviews a claim before letting doctors or other medical providers bill for healthcare services or prescriptions. Doctors say administrative actions routinely delay or deny care.
Major insurers such as UnitedHealthcare, Blue Cross Blue Shield, Cigna, Kaiser Permanente and Humana have pledged to reduce the use of prior authorizations.
UnitedHealthcare also said it would implement “authorization waivers” for some procedures at some pediatric hospitals. These exemptions will be based on children’s hospitals’ “consistent use of well-established care practices,” UnitedHealthcare said in a news release.
Although UnitedHealthcare did not name hospitals that qualify for such waivers, the insurer said the hospitals are part of a “large network of nationally recognized pediatric centers spanning medical and surgical specialties.”
The insurer said it would eliminate prior approval requirements for other pediatric services, such as some diagnostic imaging, sleep studies and routine out-of-hospital tests. UnitedHealthcare will maintain prior approval requirements for complex care and experimental treatments.
The changes to child care reviews will apply to people covered by UnitedHealthcare’s private insurance and Medicaid, the federal-state health care program for low-income families and some people with disabilities.
UnitedHealthcare has promised to reduce previous authorizations for some outpatient surgeries, diagnostic tests such as echocardiograms, outpatient treatments and chiropractic care by the end of 2026, as part of its previously announced initiative to reduce administrative hurdles for patients of all ages.
This article first appeared on USA TODAY: UnitedHealthcare reduces use of prior authorization for children
