UnitedHealth talks the talk about cutting prior authorization requirements and, in fact, continues to rely heavily on them. Yes, UnitedHealth volunteered to cut 30 percent of its prior authorization requirements. And, it claims to be cutting 1,700 medical codes on October 1. But, as it turns out, fewer than five percent of these codes apply to people in Medicare Advantage plans, reports Gerelyn Terzo for 247Wallst.
By one advocacy group’s count, UnitedHealth is only eliminating roughly 70 codes in Medicare Advantage. What’s more troubling is that even when UnitedHealth eliminates a code, it does not mean that it will pay a bill. Put differently, UnitedHealth might not be requiring preapproval of a service, but it might not approve coverage for the service after it has been performed.
People in traditional Medicare do not have to deal with prior authorization. They rarely face hurdles before getting care and never are faced with a bill after they receive care for Medicare-approved services.
UnitedHealth is cutting some prior authorization requirements for people in some health plans requiring cancer care, heart care, orthopedic and musculoskeletal procedures, genetic and lab testing, chiropractic care, physical, occupational and speech therapy, home health services, and durable medical equipment.
To the extent that some people will face fewer prior authorization obstacles, Wendell Potter explains that “A lot of what’s on the list is low-stakes.” If people are not using the services requiring prior authorization most of the time or are getting approval for the services most of the time, UnitedHealth is doing little if anything to address the dangers of prior authorization.
Moreover, even if there’s no prior authorization for a service, people often still must find an in-network provider to perform the service, get a referral from a primary care physician, pay the copay, and overcome a review of the medical necessity of the procedure after it is performed.
In 2025, KFF found that insurers denied 15 percent of prior authorization requests. Medicare Advantage insurers denied 12 percent of prior authorization requests, though UnitedHealth’s Medicare Advantage denial rate was 17 percent.
What can you do to be sure you are not stuck with a bill after you receive a service? Ask for a pre-service organization determination. Only a formal determination gets you a confirmation that the procedure will be covered.
Here’s more from Just Care:
- AHA warns Medicare oversight agency about dangers of Medicare Advantage
- Prior authorization in Medicare Advantage harms patients, sometimes severely
- Oncologists report excessive deaths from prior authorization
- Prior authorization: What is to be done?
- Some doctors charge patients for prior authorization
