UnitedHealthcare to ditch prior authorization for most pediatric imaging
UnitedHealthcare is planning to discontinue prior authorization for most pediatric medical imaging, the company announced Monday.
The country’s largest commercial payer said the switch will begin on Dec. 1, with it no longer requiring preapproval for 2,000 different pediatric care codes. These include MRI and CT scans, joint and cardiac procedures, and certain radiation therapy services.
UnitedHealthcare said it is fast-tracking care “widely considered” to be safe and effective, resulting in an almost two-thirds decline in prior authorization volume.
“Every child deserves a healthcare experience centered on their needs,” CEO Tim Noel said in a statement Nov. 2. “These changes will help make that experience simpler for children, their families and the physicians who care for them.”
UnitedHealthcare said the changes apply across its commercial, individual exchange and “community” plans. You can find the full list of all 2,000 codes here. Other insurance types are being excluded from the change, including dual-eligible special needs plans, Medicare Advantage, and Nevada’s Medicaid offering.
UnitedHealthcare said the changes follow its May commitment to eliminate nearly two-thirds of pediatric prior authorization requirements. Select complex services will still require preapproval, including certain injectable medications, genetic tests, surgical procedures, and those that are required to be managed by state regulations.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.