UnitedHealthcare, one of the nation's largest insurers, announced it will significantly reduce prior authorization requirements for pediatric care, a move that comes as doctors have increasingly criticized the process for delaying necessary treatment.
The company said it will remove authorization requirements for two-thirds of services for members under 18 by the end of the year. The changes apply to many diagnostic tests, routine surgical procedures, and specialty care in fields like cardiology, neurology, pulmonology, and orthopedics.
“We are conducting a rigorous, data-driven review to identify which pediatric services can be safely exempted,” a UnitedHealthcare spokesperson said. The company will still require pre-approval for services with higher clinical complexity, such as experimental treatments, specialty drugs, and those mandated by government regulation.
The policy shift is part of a broader industry trend. UnitedHealthcare earlier this month set a goal to eliminate prior authorization for 30 percent of all healthcare services by year-end. The insurer is also introducing authorization waivers for certain procedures performed at leading comprehensive pediatric hospitals, which it described as a “broad network of nationally recognized pediatric centers.”
Physicians have long argued that prior authorization creates unnecessary administrative burdens and delays care. A 2024 American Medical Association survey found that 93 percent of physicians reported care delays while waiting for insurers to authorize treatment. The survey, which represents the nation's doctors, underscores the frustration that has fueled calls for reform.
The announcement comes amid a broader political landscape where healthcare policy remains a flashpoint. For instance, the Trump administration's sinking approval ratings have been partly attributed to healthcare access issues, while debates over pediatric care costs are highlighted by data showing pediatric surgeons top the list of highest-paying jobs at $502,000 annually.
UnitedHealthcare’s decision is likely to be welcomed by patient advocacy groups and medical associations, though some critics may question whether the changes go far enough. The company’s data-driven approach aims to balance access with cost control, but the ongoing backlash suggests insurers face continued pressure to streamline approval processes.
