Unitedhealthcare Pediatric Prior Authorization Policy Linked to Delayed Care for Vulnerable Children, New Study Reveals
WASHINGTON, D.C. – A comprehensive study published Monday has identified a direct correlation between Unitedhealthcare’s pediatric prior authorization requirements and significant delays in critical medical treatments for children.
WHAT: The investigation, conducted by the National Institute for Pediatric Health Policy, analyzed over 45,000 prior authorization requests submitted to Unitedhealthcare between January 2023 and June 2024. Researchers found that 23% of denied or delayed authorizations resulted in a median delay of 18 days in initiating therapy for conditions including childhood cancers, congenital heart defects, and severe asthma.
WHEN: The data covers the 18-month period ending June 30, 2024, with the report released on February 26, 2025.
WHERE: The study examined claims data from 1,200 pediatric specialties across 35 states, with the highest impact reported in Texas, Florida, and California.
WHO: The study was led by Dr. Emily Hartfield, a professor of health policy at Georgetown University. Unitedhealthcare, the largest private health insurer in the United States, has a policy of requiring pre-approval for a range of pediatric diagnostic tests and treatments.
WHY: The report attributes the delays to a complex and inflexible prior authorization protocol, which often requires multiple steps and physician appeals. Dr. Hartfield stated, “These administrative hurdles are creating a two-tiered system where insured children are not receiving timely care, undermining the principle of pediatric safety.”
A Unitedhealthcare spokesperson issued a statement asserting the policy is “designed to ensure appropriate and cost-effective care,” adding that the company is reviewing the study’s findings. The report has prompted calls from the American Academy of Pediatrics for federal oversight of prior authorization processes for pediatric patients.