UnitedHealthcare plans to remove about two-thirds of its prior authorization requirements for patients under 18 by the end of 2026.
The insurer said May 29 the cuts will cover diagnostic services, routine surgical procedures, and specialty care across pediatric subspecialties including cardiology, neurology, pulmonology, and orthopedics. UnitedHealthcare will also stop requiring prior approval for certain procedures performed at “leading comprehensive pediatric hospitals,” though the company did not identify which facilities are included in that designation.
The changes apply to commercial and Medicaid plans. UnitedHealthcare did not disclose the total number of pediatric prior auth requirements currently in place or how many members would be affected.
The pediatric reductions are part of UnitedHealthcare’s broader commitment, announced May 5, to cut its total prior authorization volume by 30% in 2026. The company confirmed this latest action counts toward that target but has not said how much progress it has made toward the goal overall.
UnitedHealthcare has steadily reduced prior auth requirements in recent years, eliminating 20% in 2023 and launching a gold carding program in 2024 that exempts some providers for certain services. In late April, the company said it would exempt many rural providers from prior authorization and accelerate payments to roughly 1,500 rural hospitals by fall 2026. UnitedHealthcare previously said prior authorization is required for only 2% of medical services, with over 90% of submitted requests approved within 24 hours.
In June, roughly 50 insurers, including UnitedHealthcare, pledged to simplify and reduce prior authorization requirements across commercial, Medicare Advantage and managed Medicaid plans covering 257 million Americans. The same cohort has also committed to implementing standardized electronic prior authorization submissions and processing at least 80% of electronic approvals in real time by 2027.At the federal level, CMS has been layering prior auth transparency and timeline requirements onto payers while also proposing to extend the current rules to cover drugs for the first time.
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