UnitedHealthcare Eliminates Nearly Two-Thirds of Prior Authorization Requirements for Pediatric Care

About this update from Unitedhealth Group Incorporated

UnitedHealthcare is removing two-thirds of authorization requirements for members under age 18 by year’s end. This move is the latest in a series of initiatives to simplify the healthcare system for providers and patients. The company is eliminating prior authorizations for many diagnostic services, routine surgical procedures and specialty care services across pediatric subspecialties such as cardiology, neurology, pulmonology and orthopedics. UnitedHealthcare is also introducing authorization waivers for certain procedures performed at leading comprehensive pediatric hospitals, reflecting these facilities’ consistent use of well-established care practices. These hospitals represent a broad network of nationally recognized pediatric centers spanning medical and surgical specialties. “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,” said Tim Noel, CEO of UnitedHealthcare. “These changes are part of our broader efforts to simplify healthcare and allow families — and their doctors and nurses — to pursue routine care with far fewer administrative steps, while higher-risk procedures continue to undergo reviews.” UnitedHealthcare is conducting a rigorous, data-driven review of all pediatric prior authorization requirements to determine which services can be safely removed while maintaining high standards of clinical quality and patient safety. The company will eliminate pre-approval for certain pediatric services, including some diagnostic imaging; reviews of where care is provided; sleep studies; routine outpatient testing; and select surgical and therapeutic procedures that are consistently approved. UnitedHealthcare 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 changes apply to UnitedHealthcare’s commercial and Medicaid plans. Recent efforts to simplify the healthcare system Today’s announcement builds on an ongoing effort to improve and simplify patient and care provider experiences and lower costs for consumers, including: Reducing over time the number of services that require prior authorization, including a May 5, 2026, commitment to cut prior authorization requirements by 30% in 2026; today’s announce...

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