UnitedHealthcare Scales Back Prior Authorization Requirements for Pediatric Care

UnitedHealthcare is set to eliminate about two-thirds of prior authorization requirements for children it covers by the end of the year.

The insurer said on Friday that it will remove prior authorization for a wide range of services for members under 18, including certain diagnostic tests, routine surgeries, and specialty care spanning cardiology, neurology, pulmonology, and orthopedics.

UnitedHealthcare also said it will introduce “authorization waivers” for select procedures performed at leading pediatric hospitals, citing those institutions’ “consistent use of well-established care practices.”

The company did not identify which hospitals will qualify for the waivers, but said the program will include a broad network of “nationally recognized pediatric centers spanning medical and surgical specialties.”

Prior authorization requires clinicians to obtain approval from an insurance provider before delivering certain services, tests, or treatments. While insurers say the process helps ensure care is appropriate and cost-effective, it has become a major frustration point for providers and patients who say it adds too much administrative burden and can cause delays.

“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, who became CEO of UnitedHealthcare in January 2025, said in the announcement.

“These changes are part of our broader efforts to simplify healthcare and allow families—and their doctors and nurses—to pursue routine care with far fewer administrative steps, while higher-risk procedures continue to undergo reviews,” Noel added.

UnitedHealthcare said it is conducting a broader review of pediatric prior authorization to determine which requirements can be removed without compromising safety or quality. The company said it expects to eliminate pre-approvals for certain types of diagnostic imaging, sleep studies, routine outpatient testing, and some surgical services and therapies that are typically approved.

Prior authorization will remain for services involving higher clinical complexity or variability—such as experimental treatments—or where it is required by regulation, the insurer said.

The changes will apply to members covered through UnitedHealthcare’s commercial plans as well as Medicaid, the federal-state jointly funded health program for low-income families and some people with disabilities.

The pediatric rollback follows other recent efforts by the insurer to pare back prior authorization. In April, UnitedHealthcare said it would waive most prior authorization requirements for medical care at roughly 1,500 rural hospitals and their affiliated providers by the fall.

UnitedHealthcare is not alone in scaling back prior authorization. Rivals including Aetna, a CVS Health unit, and Cigna have announced their own reductions.

Industrywide, prior authorization requirements are estimated to have fallen 11 percent since a coordinated reform push began in 2025, according to AHIP, the health insurance industry trade group. That accounts for about 6.5 million fewer prior authorization requests for patients.