Which services commonly require prior authorization in UnitedHealthcare plans?

• A. Routine vaccinations
• B. Certain inpatient admissions, surgeries, high-cost imaging, and specific therapies
• C. All emergency room visits
• D. Routine office visits

Answer: (B)

Prior authorization is a pre-approval process used by health plans to confirm that a proposed service is medically necessary and covered before the service is performed. This is especially important for high-cost or complex care, where the plan needs to review the medical need, the appropriate setting, and the expected benefit before approving the service.

For UnitedHealthcare plans, services that commonly require prior authorization include certain inpatient admissions, surgeries, high-cost imaging, and specific therapies because these involve substantial costs and significant impact on care pathways. Requiring approval helps ensure the care is appropriate, aligns with benefits, and supports coordination among the care team.

Routine vaccinations and routine office visits are typically low-cost and preventive or standard care, so they usually do not require prior authorization. Emergency room visits are for urgent conditions where delaying care to obtain authorization could be harmful, so initial emergency evaluation and treatment are generally not held up for pre-authorization (though some plans may do post-service review).

So, the services described—high-cost, complex, or inpatient-related procedures and therapies—are the ones most commonly needing prior authorization.