Two-thirds of prior approvals for children’s healthcare are to be scrapped by the largest insurer in the United States, UnitedHealthcare, in a sweeping overhaul aimed at cutting red tape and speeding up treatment. The company announced that it will eliminate prior-authorisation requirements for approximately two-thirds of healthcare services for members under 18, with full implementation expected by the end of the year.
What Prior Authorisation Is and Why It Is Being Removed
Prior authorisation (PA) is a process in which a health insurer must pre-approve certain medical services, tests or prescriptions before a patient can receive them. The system has long been a source of friction between insurers and healthcare providers, with critics arguing it creates unnecessary delays, burdens administrative staff and frustrates patients. For paediatric care specifically, doctors have warned that PA can lead to prolonged hospital stays and worse clinical outcomes for children.
UnitedHealthcare’s move responds directly to those concerns. The insurer said the changes are intended to reduce delays and ease administrative burdens, addressing widespread complaints from both patients and doctors. The eliminated prior approvals will cover a broad range of services, including many diagnostic procedures, routine surgical operations, and specialist care across paediatric subspecialties such as cardiology, neurology, pulmonology and orthopaedics. The company is also introducing authorisation waivers for certain procedures performed at leading comprehensive paediatric hospitals, recognising that those institutions already follow established best-practice protocols.
CEO on the Rationale
Tim Noel, chief executive of UnitedHealthcare, said: “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.” Noel, who took over the role after the assassination of his predecessor, Brian Thompson, in December 2024, has been with UnitedHealth Group since 2007 and previously led the company’s Medicare and retirement division.
UnitedHealthcare is conducting what it described as a “rigorous, data-driven review” of all paediatric prior-authorisation requirements, with the aim of identifying further services that can be safely removed from the approval process. The changes apply to both the insurer’s commercial and Medicaid plans.
Industry-Wide Reforms and Regulatory Pressure
The announcement is part of a broader push by American health insurers to overhaul the prior-authorisation system. In June 2025, more than 50 insurers — including UnitedHealthcare, CVS Health’s Aetna, and Cigna — pledged to streamline and reduce PA requirements, improve transparency and accelerate electronic processing. By April 2026, participating plans had collectively cut PA requests by 11%, equivalent to 6.5 million fewer requests. Medicare Advantage plans saw a reduction of more than 15%.
Standardisation of data and submission requirements has been a central element of the reforms. UnitedHealthcare and CVS Health’s Aetna reported last month that they had already standardised more than half of their prior authorisations. UnitedHealthcare anticipates that over 70% of its PA volumes will be part of this new standardised submission process by the end of the year.
These voluntary industry efforts are running alongside regulatory changes. The Centers for Medicare & Medicaid Services (CMS) finalised an Interoperability and Prior Authorization rule in January 2024, which mandates faster processing times — 72 hours for urgent requests and seven calendar days for standard ones. CMS has also proposed extending electronic PA to drugs and requiring standardised data submission.
Despite the progress, physician groups argue that PA remains a heavy burden. The American Medical Association (AMA) conducted a survey in which 94% of physicians reported that PA leads to delays in patient care, and 78% said patients abandon treatment altogether because of the process. For patients with chronic conditions, the burden is said to be particularly acute.
UnitedHealthcare’s History of Controversy
UnitedHealth Group, the parent company of UnitedHealthcare, has faced a series of controversies over its business practices. These include antitrust lawsuits, allegations of stock manipulation, investigations into so-called upcoding (billing for more expensive services than were provided), and accusations of systematically denying care.
In September 2024, the company introduced new PA requirements for outpatient physical, occupational and speech therapy services under its Medicare Advantage plans — a move that was met with widespread confusion and frustration from providers, who complained of poor communication. In May 2025, UnitedHealth Group was fined $475,000 by the California Department of Managed Health Care for failing to implement independent prior-authorisation decisions in a timely manner, which led to further delays in patient care.
The assassination of former CEO Brian Thompson on 4 December 2024 cast a harsh spotlight on the insurer’s claim-rejection practices. Thompson had faced criticism over UnitedHealthcare’s high rate of claim denials, and his family reported that he had received death threats. The words “delay”, “deny” and “depose” were found inscribed on the cartridge cases used in the shooting. Luigi Mangione was arrested and charged with murder.
Leading Paediatric Hospitals and the Waiver Programme
UnitedHealthcare’s new authorisation waivers for certain procedures will apply at a select group of leading comprehensive paediatric hospitals. These institutions are typically those ranked by U.S. News & World Report and include Boston Children’s Hospital, Children’s Hospital of Philadelphia, Cincinnati Children’s Hospital Medical Center, Texas Children’s Hospital, Children’s Hospital Los Angeles, Nationwide Children’s Hospital, and others recognised for their specialist paediatric care.
