UnitedHealthcare’s 1,700 Prior Auth Cuts Draw Muted Applause

UnitedHealthcare’s (UHC) announcement Tuesday that it’s removing 1,700 more procedures from its prior authorization list was met with general approval, although some experts questioned how much of a difference it would make.

“A lot of what’s on the list is low-stakes: minor skin lesion excisions, routine injections, hearing-aid accessory codes, prosthetic components, and — notably — a large number of ‘unlisted procedure’ placeholder codes that are rarely billed at all,” Wendell Potter, former vice president of corporate communications at a leading health insurance company, said in an email. “Removing prior authorization from codes nobody uses generates a big number at no real cost to UHC.”

What’s largely absent from the list, Potter said, is “specialty pharmacy/injectable drugs, GLP-1s, most oncology drug regimens, and most cardiac device implants — the categories that actually drive the PA [prior authorization] controversy and cost exposure.”

The list of codes was announced in UHC’s monthly Network News bulletin. The bulletin says only that the change will apply to “30% of prior authorization requirements,” but a UHC spokesperson confirmed the 1,700 number, which was reported in several news outlets. The affected types of UHC plans include:

“We know the time you spend managing prior authorizations, paperwork, and reimbursements is time you’d rather spend with your patients,” reads the bulletin announcement, which is directed at clinicians. “Removing these prior authorization requirements is part of our effort to help reduce administrative work, remove barriers that can delay care, and give you more time to focus on patient care.”

The impact of removing 1,700 codes from prior authorization requirements is likely smaller than it suggests, said Potter, who is a proponent of single-payer healthcare. “UHC’s own framing is that PA already applies to only about 2% of medical services. This cuts that by 30% — roughly 0.6 percentage points of total UHC claims volume shifting off PA. Real, but incremental.”

Michael Baker, director of healthcare policy at the American Action Forum, a right-leaning Washington think tank, said in an email that the action “is a potentially meaningful step in rethinking PA, particularly given the insurer’s size, and should reduce paperwork and treatment delays for some patients.”

But the scope of the action isn’t that clear, he said, considering that only 2% of the services covered by UHC require prior authorization, while approximately 92% of submitted requests are approved. “And eliminating PA does not necessarily mean unconditional coverage. Thus, much of the immediate benefit may be reduced paperwork burden and faster scheduling rather than a dramatic expansion in access to previously denied care.”

“United has also not disclosed how many actual authorization requests, patients, or dollars of spending those codes represent, making the 1,700 figure a somewhat imprecise measure of the change,” he added. “The important metric will be how much PA activity actually disappears once the new policy takes effect.”

Tom Campanella, a healthcare consultant in Cleveland, said in an email that UHC’s move is a positive one, because “for the specific codes that no longer require precertification process, there will be better and more quicker access to healthcare services by the patient.”

However, “there may be more work to be done, especially as it relates to the overall precertification process,” added Campanella, who was formerly vice president of healthcare finance and care management at a large Ohio insurer. “There should be full transparency during the precertification process, and guidelines should be clear to the providers of care. The timeframe for appeals should be expedited, especially when it relates to lifesaving procedures.”

On Capitol Hill, at least one legislator said that voluntary moves like UHC’s were not enough. “While it’s encouraging to see health insurance plans acknowledge that their unnecessary prior authorization requirements are preventing patients from getting the care they need, these announcements shouldn’t replace or delay much-needed legislative reforms,” Rep. Suzan DelBene (D-Wash.) said in a statement Wednesday.

“Voluntary commitments aren’t enforceable and can be changed at any time,” she said. “The way we truly reform this deeply flawed practice that worsens health outcomes is to pass the overwhelmingly bipartisan Improving Seniors’ Timely Access to Care Act. This legislation would ensure that all insurers are playing by the same rules, modernize and speed up the frustrating prior authorization process, and create the necessary transparency and accountability for those who fail to meet these new standards.” DelBene is a co-sponsor of the legislation, which currently has 302 co-sponsors.