UnitedHealthcare Reduces Most Prior Approvals For Pediatric Patients

UnitedHealthcare, the nation’s largest health insurance company, said it is “removing two-thirds of authorization requirements” for health plan members under age 18 by the end of this year.

The move comes almost a year after the nation’s health insurance companies vowed to “streamline, simplify and reduce” prior authorization, the controversial process of insurers reviewing hospital admissions and medications.

Last summer, the biggest names in health insurance, including Cigna, CVS Health’s Aetna, UnitedHealth Group’s UnitedHealthcare and Humana, were among more than 50 health insurers committing to reducing prior authorization along with simplifying business practices in general.

Those sweeping commitments were announced by America’s Health Insurance Plans, also known as AHIP, and the Blue Cross Blue Shield Association. These groups and their health plan members, which provide health benefits to more than 250 million Americans, said they “aim to accelerate decision timelines, increase transparency and expand access to affordable, quality care.”

And many have done so, announcing an array of initiatives in recent months to eliminate or reduce the need for patients to seek prior authorization. Just last month, for example, Aetna, the nation’s third-largest health insurer, said it has “already standardized 88% of its prior authorization volume.”

On Friday, UnitedHealthcare said the insurer 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.” The company said the changes apply to the insurer’s commercial and Medicaid plans for low-income Americans.

“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 UnitedHealthcare chief executive officer Tim Noel. “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.”

In addition, the company is rolling out “authorization waivers” for certain procedures performed at what the insurer called “leading comprehensive pediatric hospitals” given their “use of well-established care practices,” the health insurer said in a statement. UnitedHealthcare didn’t disclose names of the facilities that would be granted such waivers.

“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,” the insurer announced. “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.”