UnitedHealthcare announced on May 29 that it will eliminate about two-thirds of prior authorization requirements for pediatric care by the end of 2026. The changes will apply to children covered under the insurer's private insurance and Medicaid plans, removing pre-approvals for diagnostic tests, routine surgeries, and specialty care in cardiology, neurology, pulmonology, and orthopedics.
The move is part of UnitedHealthcare's broader goal to reduce prior authorizations for 30% of all healthcare services, addressing long-standing complaints that the process delays or denies care. The insurer will also implement "authorization waivers" for some procedures at select pediatric hospitals, based on their adherence to well-established care practices. While the hospitals were not named, UnitedHealthcare described them as part of a "broad network of nationally recognized pediatric centers."
Pre-approval requirements will remain for complex care and experimental treatments. The changes aim to streamline administrative processes for doctors and families, though critics argue that prior authorizations are necessary to control costs and ensure appropriate care.