Insurers cut back on Medicare Advantage
Funding cuts to Medicare will affect Minnesota residents, with UnitedHealth exiting primarily in the southern part of the state. FOX 9’s Mike Manzoni has the latest updates.
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UnitedHealthcare announced on May 29 that it will reduce pre-authorization requirements for the children it covers by two-thirds by the end of 2026.
Some of the previous authorizations that UnitedHealthcare announced it would cut or reduce include some diagnostic services, routine surgery, and specialty care such as cardiology, neurology, pulmonology and orthopedics.
The move, which targets paperwork for doctors and families, is part of the insurer’s goal announced May 5 to eliminate prior authorization requirements for 30% of medical services after complaints that paperwork delays or denies people care.
Physicians and patients have long criticized pre-authorization, the process by which insurance companies review applications before allowing doctors and other health care providers to bill for medical services or prescriptions. Doctors say administrative measures routinely delay or deny treatment.
Major insurance companies, including UnitedHealthcare, Blue Cross Blue Shield, Cigna, Kaiser Permanente, and Humana, have vowed to reduce their use of prior authorizations.
UnitedHealthcare also announced that it would implement “accreditation waivers” for some procedures at some children’s hospitals. UnitedHealthcare said in a news release that these exemptions will be based on the children’s hospital’s “consistent use of established medical practices.”
UnitedHealthcare did not name the hospitals eligible for such exemptions, but the insurer said the hospitals are part of an “extensive network of nationally recognized pediatric centers across medical and surgical specialties.”
The insurer said it would eliminate prior authorization requirements for other pediatric services, including some diagnostic imaging, sleep studies and routine testing outside of the hospital. UnitedHealthcare maintains prior authorization requirements for complex and experimental treatments.
The child care review changes will apply to people covered by UnitedHealthcare’s private insurance and Medicaid, a federal-state health care program for low-income families and some people with disabilities.
UnitedHealthcare has vowed to reduce prior authorizations for some outpatient surgeries, diagnostic tests such as echocardiograms, outpatient treatments and chiropractic care by the end of 2026 as part of a previously announced effort to lower administrative hurdles for patients of all ages.
