Payers are cutting prior auth — and pointing the freed-up volume at ASCs
UnitedHealthcare is eliminating authorization for 30% of services that required it; commercial site-of-care programs increasingly waive review for ambulatory surgery centers while keeping it on hospital outpatient departments.
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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 on May 29 removes roughly two-thirds of prior authorization for members under 18, and the eliminated categories explicitly include “reviews of where care is provided” — site-of-care review itself.
The steering shows up most plainly in commercial site-of-care policy. Aetna’s standing rule requires precertification for a defined list of outpatient surgical procedures when they are done in a hospital outpatient department, but states plainly that it “will not require precertification for the above services if they’re performed in an ambulatory surgical facility or an office.” Aetna frames the program as steering care to “the more cost-effective site of service.” Anthem markets the same logic to members directly through its Site of Service benefit, which tells enrollees they “can save money on outpatient surgery and other procedures” by using an ambulatory surgery center “to help lower your out-of-pocket costs.”
Cigna reports it has cut medical prior-auth volume by about 15%, with a standardized electronic approach set to cover more than 70% of that 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.