UnitedHealth Group mentioned Tuesday it’s planning to cease requiring medical doctors to get approvals for a slew of checks, surgical procedures and different procedures, an effort to ease affected person entry to care.
The corporate, which runs the biggest insurer within the US, will use AI to stop requiring approvals for echocardiograms, chiropractic care, sure outpatient surgical procedures and a few outpatient remedy, in accordance with a press launch.
The authorization course of has lengthy been despised by each medical doctors and sufferers, who blame the prolonged paperwork course of for slowing down — and at occasions stopping — vital remedy.
Trade giants together with CVS Well being’s Aetna and Cigna Group have pledged to ease authorizations in an effort to quell heated backlash in opposition to the healthcare system within the wake of UnitedHealthcare CEO Brian Thompson’s stunning killing in 2024.
Accused assassin Luigi Mangione ranted concerning the healthcare trade, which he wrote “extracts human life pressure for cash,” in diary entries forward of the deadly taking pictures. He’s set to go on trial this fall.
“Prior authorization is a vital safeguard however ought to solely be used when it really protects sufferers and improves care,” UnitedHealthcare CEO Tim Noel mentioned in a Tuesday assertion.
“Eliminating these necessities is another manner we’re working to make it simpler for sufferers to get the care they want after they want it and guarantee medical doctors can spend extra time with their sufferers,” he added.
Insurers have slashed about 11% of pre-authorizations since launching a joint reform effort in 2025, in accordance with well being trade organizations – although teams representing healthcare suppliers have mentioned they’ve seen restricted influence.
Noel advised the Wall Avenue Journal that the transfer is simply an early sign of how AI may help change healthcare’s complicated monetary system. The corporate will more and more have the ability to use information evaluation to flag sure healthcare suppliers with spiking patterns of questionable use, he mentioned.
The brand new AI-backed tech is not going to be used to disclaim insurance coverage claims, in accordance with the exec.
Insurance coverage firms have lengthy argued that approvals are vital to forestall costly, doubtlessly pointless procedures.
UnitedHealthcare mentioned prior authorizations are solely required for two% of its medical companies. Round 92% of authorizations are authorised in lower than 24 hours on common.
The corporate is seeking to standardize authorization necessities amongst its Medicare, Medicaid and employer plans, in addition to take away the step for companies which might be practically all the time authorised.
UnitedHealthcare beforehand launched a “gold card” program lifting approval necessities on sure healthcare supplier teams.
It’s not the primary healthcare insurer to think about using AI to repair its authorization course of.
About 68% of well being insurers have been utilizing, planning to make use of or contemplating utilizing AI to overview pre-authorizations for approval, in accordance with a survey final yr by the Nationwide Affiliation of Insurance coverage Commissioners.
About 12% mentioned the identical about insurance coverage denials, in accordance with the survey.
