Streamlining the prior authorization process for a better health care experience

Starting in Q3 2023, UnitedHealthcare will eliminate nearly 20% of current prior authorizations for common procedures or prescriptions.

Prior authorization is the process through which health care providers obtain coverage approval from a member’s health plan prior to performing certain non-emergent procedures or filling a prescription. 

While designed to ensure a health care service or medication is safe, medically necessary and effective from a quality and cost perspective, the reality is that prior authorizations can sometimes cause delays in care,1 which can be a frustrating experience for members and care providers.

For instance, say a member schedules a procedure only to discover that coverage for that procedure was denied through the prior authorization process. In addition to the delay that denial may impose, that member may have to rearrange their schedule or request additional time off work. Meanwhile, that member’s provider may have to then work with the health plan to explain and remedy the situation.

Still, prior authorizations can promote clinical quality and safety. Prior authorization can also help take unnecessary costs out of the system. For instance, waste due to overtreatment and low-value care in the U.S. is estimated at $76B to $101B annually.2

UnitedHealthcare is working to strike a balance between simplifying the health care experience for members, reducing the administrative burden for providers and ensuring care quality and safety.

In Q3 2023, UnitedHealthcare is launching an initiative that eliminates prior authorizations for common procedures, treatments and services. This will reduce the number of current prior authorizations by nearly 20%.

“While prior authorizations help protect member safety and help lower the total cost of care, we need to continue our ongoing work to ensure they don’t unnecessarily burden physicians’ workloads for safe and routine procedures.” 

— Dr. Anne Docimo, Chief Medical Officer, UnitedHealthcare

This is just the start of changes UnitedHealthcare is unveiling to simplify the health care experience for members and providers:

Creating a simpler member experience

On top of reducing prior authorizations for routine procedures and medications, UnitedHealthcare is working to provide members with greater transparency into the process through various communication efforts, including simplifying the language of prior authorization letters and notifying members through® or the UnitedHealthcare® app on the status of their prior authorization. Where appropriate, UnitedHealthcare will also proactively call members to help guide them through their coverage options.

How this impacts employers: By making the prior authorization process easier and more transparent for members, employers may not receive as many questions or complaints from their employees and overall employee satisfaction with their health plan may improve. Plus, some research shows that when employees experience delays or denials of care, they’re less productive at work, and this can affect employers’ bottom lines.3

Reducing the administrative burden for providers

Another initiative, launching early 2024, is the UnitedHealthcare Gold Card program, which will reward provider groups who consistently practice evidence-based care as demonstrated by high approval levels on prior authorization requests. It will eliminate most prior authorizations for eligible provider groups — not just for individual providers. Qualifying provider groups will follow a simple administrative notification process for most procedure codes rather than the prior authorization process.

This will also help remove some of the administrative burden experienced by providers, allowing them to spend more time with their patients, which has proven to help reduce burnout.4

How this impacts employers: Streamlining the prior authorization for providers can trickle down into the member experience. Less time spent on navigating the prior authorization process may enable providers to dedicate more time to their patients, which can result in better health outcomes and higher health plan satisfaction among employees.

Some could say it’s a win-win-win for members, providers and employers!

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