UnitedHealth talks the talk about cutting prior authorization requirements but, 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 prior authorization for 1,700 medical codes on October 1. As it turns out, however, 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 prior authorization for a particular code, it still might not cover the service and pay a bill. 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 reports that it is cutting some prior authorization requirements in some health plans for people 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.
Some people will face fewer prior authorization obstacles, but 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 when there’s no prior authorization requirement for a service, people can still encounter multiple obstacles to care. They might struggle to find an in-network provider to perform the service, need a referral from a primary care physician, and come up with the money to cover the cost of the copay.
In 2025, KFF found that insurers denied 15 percent of prior authorization requests. Overall, Medicare Advantage insurers denied an average of 12 percent of prior authorization requests. 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 insurer will pay for the procedure.
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
