UnitedHealthcare eliminates prior authorizations for 2,000 pediatric procedures
UnitedHealthcare continues to make good on its commitment to reduce prior authorizations, eliminating 2,000 medical codes associated with pediatric services, the company announced Monday. The change will begin on Dec. 1.
Eliminated codes, which effectively means providers will not have to seek prior approval for patient care associated with the services, including a wide range, from oncology to orthopedics to common surgeries.
Diagnostic imaging to identify cancer, sleep studies, treatment of joint injuries, tonsil examinations and surgeries, as well as ear care, will all be easier for providers to deliver without pre-approval from a patient’s UnitedHealthcare plan—as long as they’re linked to the treatment of an infant or minor.
“Every child deserves a healthcare experience centered on their needs,” Tim Noel, CEO of UnitedHealthcare, said in the announcement. “These changes will help make that experience simpler for children, their families and the physicians who care for them.”
The insurance company said the decision was made after agreeing with consensus from the medical community that services associated with the codes are “safe and effective.”
The shift should reduce the volume of pediatric codes for prior authorizations by two-thirds, UnitedHealthcare added, saying the policy change will free caregivers to “spend more time focused on patients.”
Pediatric patients, for the purpose of these codes, are defined as any patient under the age of 18.
The company warned that some pediatric services will continue to require advance notification, meaning that providers need to ensure they are providing care linked to the specific codes being eliminated.
Providers are advised by the insurer to use the UnitedHealthcare Provider Portal to ensure they are in alignment with the expectations for reimbursement, as they could shift some based on a member’s plan.
Reducing administrative burden
In September, UnitedHealthcare eliminated 1,700 prior authorization codes, associated with common diagnostics and treatments linked to a variety of specialties.
That move, and the elimination of pediatric approvals, is part of a larger plan to eliminate the prior authorization process entirely for 30% of all healthcare services before the beginning of 2027, the company said.
At the time, the changes applied in only 11 states as part of a phased rollout. North Carolina and Texas saw the most relief, as the insurer said it was focusing on rural areas.
Prior to that announcement, UnitedHealthcare had said it would begin issuing waivers to rural hospitals, to allow them to conduct certain patient care activities without fear of not being reimbursed.
That program began on Nov. 1, coming after a successful pilot, where UnitedHealthcare said reimbursement payments were processed 50% more quickly for about 1,400 hospitals located in rural America.
In May, UnitedHealthcare CEO Tim Noel framed the ongoing efforts to reduce prior authorizations as "one more way we are working to make it easier for patients to get the care they need when they need it and ensure doctors can spend more time with their patients."
“Prior authorization is an essential safeguard but should only be used when it truly protects patients and improves care,” he added.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.