Payers are cutting prior auth — and pointing the freed-up volume at ASCs
UnitedHealthcare is eliminating authorization for 30% of services that required it; Anthem's Colorado plan now requires precertification for hospital-outpatient surgery while waiving it for ASCs.
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The commercial prior-authorization wall is coming down selectively — and the openings point at ambulatory surgery centers.
UnitedHealthcare announced in May it will eliminate authorization requirements for 30% of services that previously needed approval by the end of 2026, including “select outpatient surgeries.” A follow-on pediatric action removes roughly two-thirds of pediatric prior authorization, explicitly including “reviews related to where care is provided.”
Anthem’s Colorado commercial plan made the steering mechanical: its Site of Care expansion, effective April 1, extends precertification requirements to musculoskeletal and surgical procedures “scheduled at an outpatient hospital setting” — while procedures done in ASCs avoid the review. The notice sells it directly: members “can expect reduced out-of-pocket expenses when procedures are performed in more cost-effective settings like ASCs.” Aetna’s standing policy works the same way for a defined surgical list.
Cigna reports it has cut medical prior-auth volume about 15%, with standardized electronic requests covering more than 70% of volume by year-end.
The pattern is consistent: less friction overall, and what friction remains is aimed at the hospital outpatient department. For ASC operators, the commercial tailwind is now written into payer policy — the work is making sure referring practices know it.