UnitedHealthcare removing prior approval for most pediatric services

(The Hill) — Insurance giant UnitedHealthcare said it will drastically cut down its prior authorization requirements for pediatric care, as the company further scales back a process that physicians say adds an unnecessary barrier to timely and necessary medical care.

UnitedHealthcare said it is removing two-thirds of authorization requirements for members under age 18 by the end of the year.

The company said it will stop requiring physician approval for many diagnostic services, routine surgical procedures and specialty care services across pediatric subspecialties such as cardiology, neurology, pulmonology and orthopedics.

The company will continue to require pre-approval for services with higher clinical complexity or variability, including experimental treatments, specialty drugs and when required by government regulation.

The move is part of a broader effort by insurance companies to respond to a growing backlash over prior authorization requirements. The insurer earlier this month announced a goal to eliminate prior-approval requirements for 30 percent of healthcare services by the end of the year.

UnitedHealthcare said it is conducting a rigorous and data-driven review of all pediatric prior authorization requirements in order to determine which services can be safely removed.

UnitedHealthcare will also introduce authorization waivers for certain procedures performed at leading comprehensive pediatric hospitals, the company said. The hospitals are part of a "broad network of nationally recognized pediatric centers spanning medical and surgical specialties."

In 2024, more than 9 in 10 physicians (93 percent) reported care delays while waiting for insurers to authorize necessary treatment, according to a survey by the American Medical Association, which represents the nation's doctors.