UnitedHealthcare Eliminates Nearly Two-Thirds of Prior Authorization Requirements for Pediatric Care
Initiative follows a series of concrete actions in 2026 to make healthcare easier for everyone to navigate
UnitedHealthcare is removing two-thirds of authorization requirements for members under age 18 by year's end. This move is the latest in a series of initiatives to simplify the healthcare system for providers and patients.
The company is eliminating prior authorizations for many diagnostic services, routine surgical procedures and specialty care services across pediatric subspecialties such as cardiology, neurology, pulmonology and orthopedics.
UnitedHealthcare is also introducing authorization waivers for certain procedures performed at leading comprehensive pediatric hospitals, reflecting these facilities' consistent use of well-established care practices. These hospitals represent a broad network of nationally recognized pediatric centers spanning medical and surgical specialties.
"Parents should be able to spend less time having to navigate the health system and more time focusing on their children as they get the care they need," said Tim Noel, CEO of UnitedHealthcare. "These changes are part of our broader efforts to simplify healthcare and allow families — and their doctors and nurses — to pursue routine care with far fewer administrative steps, while higher-risk procedures continue to undergo reviews."
UnitedHealthcare is conducting a rigorous, data-driven review of all pediatric prior authorization requirements to determine which services can be safely removed while maintaining high standards of clinical quality and patient safety. The company will eliminate pre-approval for certain pediatric services, including some diagnostic imaging; reviews of where care is provided; sleep studies; routine outpatient testing; and select surgical and therapeutic procedures that are consistently approved. UnitedHealthcare will continue to require pre-approval for services with higher clinical complexity or variability, including experimental treatments, specialty drugs and when required by government regulation.
The changes apply to UnitedHealthcare's commercial and Medicaid plans.
Recent efforts to simplify the healthcare system
Today's announcement builds on an ongoing effort to improve and simplify patient and care provider experiences and lower costs for consumers, including:
- Reducing over time the number of services that require prior authorization, including a May 5, 2026, commitment to cut prior authorization requirements by 30% in 2026; today's announcement supports achieving that 30% reduction
- Expanding the first‑of‑its‑kind national Gold Card program, which recognizes provider groups that consistently adhere to evidence-based care guidelines
- Investing in digital tools that support electronic submission, real‑time status tracking and faster decisions
On May 11, 2026, Optum Rx announced the industry's first fully transparent, fee-based pharmacy care model. Every Optum Rx client will be offered a pricing structure with monthly, clearly defined fees per member that are independent of manufacturers' list prices or prescription volume, eliminating spread pricing and similar practices. In addition to new pricing structures, Optum is also launching digital tools that let consumers compare prices and see medication costs before visiting the pharmacy.
On April 24, 2026, UnitedHealthcare championed an industry effort to standardize electronic prior authorization submission requirements, laying the groundwork for greater automation and interoperability, and a more seamless experience for care providers and patients. More than 70% of UnitedHealthcare's prior authorizations will be part of the new standardized submission process by year‑end.
On April 20, 2026, UnitedHealthcare announced that it is expanding support for rural healthcare communities by accelerating payments to more select hospitals nationwide and exempting many rural care providers from prior authorization requirements. These actions are designed to improve financial stability for rural hospitals, ease strain on care teams and help ensure patients in rural communities can access high‑quality care when and where they need it. By fall of 2026, this program will expand to approximately 1,500 rural hospitals and their associated rural practitioners nationwide, including all Critical Access Hospitals.
On March 31, 2026, UnitedHealthcare publicly reported prior authorization metrics and maintains the data on its website, along with additional context to help care providers, members and the public better understand how prior authorization is used.
On March 16, 2026, UnitedHealthcare expanded coverage for doula care to support families throughout pregnancy, birth and the postpartum period. By Jan. 1, 2027, about 7.2 million members could have access to the offering through employer health plans.
In January, the company pledged to voluntarily eliminate and rebate any profits from its individual ACA offerings in 2026.
Together, these efforts reflect UnitedHealth Group's continued focus on reducing administrative complexity, improving the care experience and helping people access care more easily and efficiently.
About UnitedHealthcare
UnitedHealthcare is dedicated to helping people live healthier lives and making the health system work better for everyone by simplifying the healthcare experience, meeting consumer health and wellness needs, and sustaining trusted relationships with care providers. The company offers the full spectrum of health benefit programs for individuals, employers, and Medicare and Medicaid beneficiaries, and contracts directly with physicians, care professionals, hospitals and other care facilities. UnitedHealthcare is one of the businesses of UnitedHealth Group (NYSE:UNH), a diversified healthcare company. For more information, visit UnitedHealthcare at www.uhc.com or follow UnitedHealthcare on LinkedIn.
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