UnitedHealthcare recently announced it’s cutting prior authorization requirements by 30%, including for some outpatient surgeries, by the end of 2026.
Four surgeons connected with Becker’s to share their reaction to the announcement and how prior authorization has shaped their practices. They shared that the move barely scratches the surface of a system they see as fundamentally broken.
The move comes as prior authorization has become one of the most common complaints among physicians — cited for delaying care, driving up administrative costs and, in some cases, pushing patients to abandon treatment altogether.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What’s your reaction to the UnitedHealthcare cuts to prior authorization requirements? How has prior authorization shaped your practice? And what impact, if any, do you expect this kind of change to have going forward?
Zain Allison, MD. Neurosurgeon at Neurosurgery One (Denver): Reducing the amount of prior authorizations by 30% is a step in the right direction, but it does not come close to fixing the problem created by insurance companies. It feels very similar to purveyors doubling the price of goods, then putting them on sale for 30% off and trying to convince you it’s a good deal. The insurance companies are operating on the idea that perception is reality, and in this case physicians need to cut through the noise to understand the reality of this situation.
Prior authorizations lead to higher costs in our clinics due to the need to hire staff to work on prior authorizations. Prior authorizations waste our time and the time of our staff. Participating in peer-to-peer calls with physicians outside our specialty who do not know the answers to our questions (or simply refuse to answer them) is a massive waste of our time and expertise. Prior authorizations burn us out, leading to increased wait times for patients needing to see a doctor because we have all quit. Prior authorizations do increase profits for the insurance companies, who then do not pass those profits down to their employees, clients or physician associates.
Like many things in life, processes set up with good intentions can have ill effects. Prior authorizations are a great example of this. This plan for a small decrease in a rapidly increasing prior authorization market reminds me of an old saying my grandfather had about people obscuring the source of the rain when you feel water on your head.
Justin Iorio, MD. Orthopedic Surgeon at St. Joseph’s Physicians Orthopedics (Fayetteville, N.Y.): Studies have estimated that medical practices spend up to 25% of their revenue on billing, insurance and administrative requirements. Prior authorization is a major contributor to this cost. The prior authorization process results in the abandonment of care by patients, exposure to unnecessary adverse events and time-consuming appeals processes. Additionally, obtaining prior authorization — or not needing it — does not mean payment will be rendered; it can still be denied retroactively.
Michael L. Knudsen, MD. Orthopedic Surgeon and Assistant Professor of Orthopedic Surgery at Columbia University Irving Medical Center NewYork-Presbyterian (New York City): I view the announcement as an encouraging development. In general, reducing unnecessary administrative steps has the potential to make care more efficient for patients, physicians and clinical teams.
Prior authorization is a routine part of orthopedic practice and can add time and administrative work around imaging, therapy, procedures and surgery. If these changes meaningfully streamline that process while maintaining appropriate clinical oversight, I think that would be a positive step.
The practical impact will ultimately depend on which services are affected and how the changes are implemented in day-to-day practice. I’ll be interested to see how that evolves over time.
These are my personal observations based on clinical practice and do not represent an institutional position.
Brad Segebarth, MD. Orthopedic Spine Surgeon at OrthoCarolina Spine Surgery (Charlotte, N.C.): I am primary investigator in a study looking at prior authorization denials for elective spine surgery. The conclusion was that most all surgeries were eventually authorized, but only after delay and increased unnecessary spending to hit unwarranted metrics. The payers are realizing it costs more for the episode of care if they try to enforce strict guidelines that carry no evidence-based medicine to support them.
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