UnitedHealthcare, the nation's largest health insurance company, has announced a major change to pediatric healthcare. From now on, the company will eliminate most prior approvals for procedures and services for patients under 18.
The move comes almost a year after the nation's health insurance companies vowed to streamline 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, aim to accelerate decision timelines, increase transparency, and expand access to affordable, quality care.
UnitedHealthcare said the changes apply to the insurer's commercial and Medicaid plans for low-income Americans. "Parents should be able to spend less time navigating 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, allowing families, their doctors, and nurses to pursue routine care with far fewer administrative steps, while higher-risk procedures continue to undergo reviews."
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.
- Tim Noel, UnitedHealthcare CEO
The company is rolling out authorization waivers for certain procedures performed at leading comprehensive pediatric hospitals, given their use of well-established care practices. UnitedHealthcare hasn't disclosed the names of the facilities that will be granted such waivers.
UnitedHealthcare will continue to require pre-approval for services with higher clinical complexity or variability, including experimental treatments, specialty drugs, and government-regulated procedures. The company will eliminate pre-approval for certain pediatric services, such as diagnostic imaging, reviews of where care is provided, sleep studies, routine outpatient testing, and select surgical and therapeutic procedures that are consistently approved.
This change comes as a relief to many parents who've had to navigate the complex process of prior authorization for their children's care. By reducing the administrative burden, UnitedHealthcare is making it easier for families to access the care they need.
The company's commitment to simplifying healthcare is part of a broader trend in the industry. Many health insurers have been working to reduce prior authorization and make it easier for patients to access care. This change is a significant step forward in that effort, demonstrating the company's dedication to making the healthcare system more patient-centered and navigable.
UnitedHealthcare's announcement highlights the complexity and frustration that patients and families often experience in the healthcare system. However, with the right changes, it's possible to create a more streamlined and accessible system.
UnitedHealthcare's goal is to make it easier for families to access routine care while ensuring that more complex procedures still undergo review. By eliminating most prior approvals for pediatric patients, UnitedHealthcare is making it easier for parents to focus on their children's care and provide them with the best possible treatment.
This change is a major development in the industry and will likely have a significant impact on families and pediatric healthcare providers. The shift aims to put patients at the forefront of the healthcare system, where they deserve to be, and will contribute to a more efficient and effective healthcare system.