UnitedHealthcare Pediatric Prior Authorization Delays Linked to Increased Hospitalizations in Five States, New Study Finds
CHARLOTTE, NC – A peer-reviewed study published Wednesday in the Journal of Clinical Outcomes Management reveals a direct correlation between UnitedHealthcare’s prior authorization requirements for pediatric services and a 14% increase in preventable hospitalizations across five Midwestern states over the past 18 months. The analysis, conducted by researchers at Children’s Mercy Hospital, examined 12,000 cases where care was delayed for an average of 3.2 days due to the insurer’s approval process. The study focused on conditions including pediatric respiratory infections and epilepsy treatments. A UnitedHealthcare spokesperson stated that the company's “clinical review process is designed to ensure appropriate care” and cited a separate internal review showing that 92% of pediatric authorizations are processed within 72 hours. The findings have reignited a national debate over insurer protocols for children prior to the upcoming regulatory review in Washington.