UnitedHealthcare Reduces Prior Authorization for Select Procedures

UnitedHealthcare has announced that it will be removing prior authorization for approximately 1,700 medical procedures starting in October. However, this change only applies to a small subset of its Medicare Advantage members, with around 120 codes being affected.

The decision comes after an analysis by the Kaiser Family Foundation found that UnitedHealth Group denied 17% of standard Medicare Advantage prior authorization requests in 2025, which is the highest rate among six large insurers examined. This rate is significantly higher than the average across these insurers, which was around 12%. The company has stated that it will be targeting a reduction in prior authorization volume and requirements for pediatric care, aiming to eliminate nearly two-thirds of such requirements by the end of this year.

It's essential for Medicare Advantage members to verify whether their specific procedures require prior authorization. Members can check if their codes are on UnitedHealthcare's Medicare Advantage list, which is distinct from other lists, including commercial plans and Oxford plans. If a request is denied, it's crucial to appeal the decision, as 67% of overturned standard Medicare Advantage denials were overturned across insurers studied.