UnitedHealthcare mentioned on Tuesday it’s eliminating “prior authorization” necessities for 30% of medical companies that beforehand required insurer approval, a coverage shift that would remove pink tape and pace entry to affected person care.
The transfer comes amid strain on the medical health insurance trade to restrict prior authorizations, the method by which well being care suppliers comparable to docs or hospitals receive approval from sufferers’ insurance coverage carriers to ship care.
Prior authorizations have lengthy drawn criticism for the time they require of physicians’ workplaces and for hindering sufferers’ entry to care, with the American Medical Affiliation discovering that such workplaces spend a mean of 12 hours per week looking for insurer approval for medical therapies.
Critics say these hours could be higher spent offering medical care, whereas some sufferers report being denied remedy by their insurance coverage firms.
UnitedHealthcare, the biggest U.S. well being insurer, mentioned in a assertion that prior authorization is required for two% of the medical companies lined below its insurance policies. About 92% of these are authorised inside 24 hours, the corporate mentioned.
“Prior authorization is a vital safeguard however ought to solely be used when it actually protects sufferers and improves care,” UnitedHealthcare CEO Tim Noel mentioned in an announcement. “Eliminating these necessities is another manner we’re working to make it simpler for sufferers to get the care they want after they want it and guarantee docs can spend extra time with their sufferers.”
Former UnitedHealth CEO Brian Thomson was shot and killed in December 2024. The suspect within the capturing, Luigi Mangione, is awaiting trial in each federal and state courtroom.
Which therapies will now not require prior authorizations?
UnitedHealthcare mentioned the next procedures will now not require prior authorization:
- Choose outpatient surgical procedures
- Some diagnostic assessments, comparable to echocardiograms
- Some outpatient therapies
- Some chiropractic care
In its assertion, the corporate mentioned it could submit the complete record of companies at UHCProvider.com earlier than the adjustments take impact.
When does this take impact?
UnitedHealthcare mentioned it would implement the adjustments by the top of 2026.
Are different well being insurers lowering prior authorizations?
Final yr, a bunch of insurers represented by Well being Insurance coverage Plans (AHIP), a commerce affiliation for the medical health insurance trade, mentioned a few of its greatest members would take steps to streamline prior authorization.
They embrace many Blue Cross Blue Protect insurers, comparable to Blue Cross Blue Protect of California, in addition to massive insurers comparable to Humana, Kaiser Permanente and UnitedHealthcare.
