UnitedHealthcare Pediatric Prior Authorization Changes Draw Scrutiny from Lawmakers and Advocacy Groups
NEW YORK, NY — UnitedHealth Group, the nation's largest private health insurer, has implemented revised prior authorization policies for pediatric care, effective this fiscal quarter, sparking debate among medical professionals and patient advocacy groups. The updated protocols, which require pre-approval for a broader range of diagnostic tests and treatments for children under 18, were announced in a company bulletin on Monday.
Company officials stated the new guidelines aim to standardize care across its networks and reduce unnecessary medical spending, citing internal data suggesting a 15% increase in pediatric imaging requests over the past year. However, the American Academy of Pediatrics released a statement Tuesday expressing concern that the changes could delay critical interventions for conditions such as autism spectrum disorders and pediatric cancer.
According to a report from the National Health Law Program, prior authorization denials for children under UnitedHealthcare plans rose 22% in the first quarter of this year compared to the same period last year. Advocacy groups have cited cases where families waited up to 14 days for approval of essential therapies, including speech and occupational services.
The policy shift comes amid a backdrop of ongoing congressional hearings on insurance market consolidation and its impact on patient access. UnitedHealthcare has committed to a 30-day review period for all pediatric authorization requests and says it will expedite urgent cases pending patient safety.