UnitedHealthcare says it will reduce the number of prior authorization requirements for patients under 18 by about two-thirds by Dec. 31.
The changes will cut prior authorization requirements for commercial health plans, as well as for Medicaid plans, and the shift will affect reviews for many diagnostic services and routine surgical procedures, the company said.
The effort will also affect reviews of care for children in some specialties, such as heart care, lung care and bone care.
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UnitedHealthcare hopes to grant even broader exemptions from prior authorization requirements for some top children’s hospitals.
“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 making the announcement as it and its competitors are trying to show that they are serious about supporting efforts by the Centers for Medicare & Medicaid Services to reduce the burden of prior authorization reviews on patients and physicians.
A majority of the physicians who participated in a recent survey organized by the American Medical Association noted that UnitedHealthcare previously said it would slash prior authorization requirements for about 1,500 rural hospitals.
Physicians, executives thrilled with news about prior authorization
Many physicians and hospital executives have welcomed the UnitedHealthcare announcement.
Mandi Roney, a benefits consultant in Vancouver, Wash., said she hopes more employers with self-insured health plans will take steps to reduce the prior authorization requirements in their plans.
“If a service is routinely approved, anyway, sometimes removing friction is simply a market correction and a better way to administer a plan,” Roney wrote in a post on LinkedIn.
Kevin Barron, vice president of payer relations at University Health and San Antonio, said he wishes UnitedHealthcare had released more details about current and future prior authorization efforts.
The company has not released any data on its current pediatric prior authorization review program or any predictions about how many patients the proposed changes might affect, Barron said. They doubted that the voluntary push to reduce prior authorization volume would help them much.
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