UnitedHealthcare (UHC) is the largest health insurer in America, covering more than 29 million people, according to the American Medical Association (1). Unfortunately, as CNBC reported last year, it has also become the “face of America’s health insurance frustrations” (2).
The fatal shooting of the company’s CEO Brian Thompson in December of 2024 brought to the forefront the intense frustrations people have with UHC. In fact, his death prompted calls for reforms and criticisms of the insurance industry’s focus on profits over people.
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UHC was even sued by shareholders (3) for allegedly misrepresenting the impact of the public backlash on its business, which the shareholders claimed caused a sharp drop in the stock price.
Now, however, UnitedHealthcare has actually made a positive move, announcing a new policy that will cut red tape and make it easier for some patients to get the medical services they need.
UnitedHealthcare makes a major change to open up access to care
UnitedHealthcare issued a news release on May 5 (4), announcing the big change that many policyholders will welcome. The insurer said it is eliminating prior authorization requirements for 30% of health care services that previously required approval.
A full list will soon become available on UHCProvider.com (5), and the changes will go into effect by the end of 2026. UHC has already said that the prior authorization requirements would be eliminated for:
Echocardiograms and certain other diagnostic tests
Some outpatient surgeries
Some outpatient therapies
Chiropractic care
“Prior authorization is an essential safeguard but should only be used when it truly protects patients and improves care,” Tim Noel, CEO of UHC, said in the statement announcing the change.
“Eliminating these requirements is 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. We are committed to further improving and refining our processes to make reviews quicker, simpler, and more efficient.”
It’s worth noting that UHC did have the highest denial rates in the industry in the past, according to a ValuePenguin report (6). A Senate report (7) also criticized the insurer for high denial rates for nursing care to stroke victims on its Medicare Advantage plans, and it was sued (8) for using AI to deny claims.
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How does eliminating prior authorizations help patients?
As the Alabama Department of Insurance (9) explains, prior authorization means your doctor must get your health insurer’s permission before it can provide health care services or prescribe prescription drugs. If the doctor doesn’t get this prior authorization, the care won’t be covered.
When an insurer authorizes care, it is supposed to make the decision on approval by checking whether the care is medically necessary, safe, or cost-effective. However, many people believe that those decisions should be made by a doctor, not by an insurance company.
And a 2024 survey (10) by the American Medical Association also found some startling stats about prior authorization. Specifically:
93% of doctors reported care delays when a procedure required prior authorization
82% reported that prior authorization requirements lead to patients abandoning treatment plans in at least some cases
31% said prior authorization criteria are rarely or never evidence-based
94% said that PA requirements have a somewhat or significant impact on clinical outcomes
The insurer’s decision is also part of a broader trend, as The Hill (11) reports that several major insurers responded to pressure to modify prior authorization rules last year with a pledge to reform the process.
For now, policyholders with UHC should watch the company’s website for the full list of services. And anyone buying health insurance coverage can check the Summary of Benefits and Coverage (SBC) (12) or the insurer’s website for the prior authorization list. That way, you’ll know in advance how often their insurer will require them to get permission before getting the care their doctor recommends.
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Article sources
We rely only on vetted sources and credible third-party reporting. For details, see our ethics and guidelines.
American Medical Association (1),(10); CNBC (2),(3); UnitedHealthcare (4),(5); ValuePenguin (6); U.S. Senate Committee on Homeland Security and Governmental Affairs (7); STAT News (8); Alabama Department of Insurance (9); The Hill (11); Cigna (12)
This article originally appeared on Moneywise.com under the title: Major US health provider drops prior authorization for 30% of services — and 93% of doctors say it’s long overdue
This article provides information only and should not be construed as advice. It is provided without warranty of any kind.
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