UnitedHealthcare cuts approvals 30%

UnitedHealthcare said on May 5 that it would eliminate prior-authorization requirements for 30% of the healthcare services that still require advance insurer approval, extending a broader industry push to scale back one of the most contested parts of medical coverage. The insurer said the changes will be completed by the end of 2026 and will cover select outpatient surgeries, some diagnostic tests including echocardiograms, and certain outpatient therapies and chiropractic care. (unitedhealthgroup.com) The company said prior authorization is currently required for 2% of its medical services, and that about 92% of submitted requests are approved in less than 24 hours on average. The move comes as insurers, providers and regulators are also focusing on the software behind coverage decisions. (unitedhealthgroup.com) The Association of Health Care Journalists said on May 14 that insurers are increasingly embedding artificial intelligence into prior-authorization and coverage workflows. A National Association of Insurance Commissioners survey found 84% of health insurers reported using AI or machine learning in some capacity, while a Stanford policy brief said 37% reported using AI for prior authorization and 56% for utilization-management activities more broadly. ### Which services is UnitedHealthcare removing from prior authorization? UnitedHealthcare said the rollback will apply to select outpatient surgeries, some diagnostic tests such as echocardiograms, and certain outpatient therapies and chiropractic care. (unitedhealthgroup.com) The insurer said a full list will be published before the changes take effect. By the end of 2026, the company said it will also route more than 70% of its prior authorizations through a standardized electronic submission process. On April 24, UnitedHealthcare said it backed an industry effort to standardize electronic prior-authorization submission requirements, which it said was aimed at automation and interoperability. (healthjournalism.org) ### How large is the cut in practical terms? UnitedHealthcare said the 30% figure refers to the set of services that still require prior authorization, not to all medical services it covers. The company said prior authorization now applies to only 2% of its medical services. (unitedhealthgroup.com) Managed Healthcare Executive, citing the company’s release, reported that physicians still face a sizable administrative load even as insurers trim requirements. The publication said doctors complete about 39 prior-authorization requests a week, underscoring how often the process still reaches clinical practice. (unitedhealthgroup.com) ### Why is AI part of this story? The Association of Health Care Journalists said in a May 14 briefing that AI is increasingly shaping medical coverage decisions and pointed reporters to recent coverage from Health Affairs, the American Medical Association, the Washington Post and Advisory Board. KFF Health News reported in April that major health insurers and Medicare are using AI to make coverage decisions, and that class action lawsuits have accused insurers of using AI to wrongfully withhold treatment. (unitedhealthgroup.com) A Stanford Health Affairs paper published in 2026 said AI can increase efficiency in utilization review but can also amplify existing flaws if it is trained on past denial patterns. Michelle Mello, a Stanford professor and co-author, said researchers saw “real positives alongside the risks,” while warning that weak human oversight and opaque tools could worsen wrongful denials. (managedhealthcareexecutive.com) ### What are other insurers saying about prior authorization? AHIP and the Blue Cross Blue Shield Association said on April 7 that participating health plans had reduced prior-authorization requirements by 11% across covered markets, including a reduction of more than 15% in Medicare Advantage. The groups said that equated to 6.5 million fewer prior authorizations for patients since the commitments were announced. (healthjournalism.org) Kim Keck, chief executive of the Blue Cross Blue Shield Association, said the next target is to address 80% of electronic prior-authorization requests in real time. That goal places speed and automation at the center of the industry’s next phase of changes. (healthaffairs.org) ### What comes next for patients and doctors? UnitedHealthcare said the next concrete step is publication of the service list on UHCProvider.com before the changes take effect. The company also said the broader program includes expansion of its Gold Card program and separate relief for rural providers announced on April 20, including faster payments and exemptions from prior authorization for many rural care providers. (ahip.org) By year-end 2026, UnitedHealthcare said more than 70% of its prior authorizations will be part of the new standardized submission process. That timetable, along with the promised service list, will give providers their next checkpoints for measuring how much of the company’s prior-authorization process actually changes. (ahip.org) (unitedhealthgroup.com)