unitedhealthcare pediatric prior authorization data reveals 17% of denied claims are later overturned on appeal, internal audit shows.
Deep inside a server room rarely accessed by even the highest-ranking officials, a leaked internal audit has surfaced, and it's not pretty. The document shows thousands of pediatric cases where vital treatments were initially blocked by the automated prior authorization system, only to be greenlit weeks later after a human reviewed the same charts. The discrepancy isn't just a glitch—it's a calculated gatekeeping play. We're seeing a pattern of 'delay until they go away' that costs families precious time and, tragically, sometimes a child's window for effective care. This isn't a bug; it's a feature with a price tag.