UnitedHealthcare has specific procedures for filing a claim appeal. In situations where the denial stems from inadequate or incorrect information on the initial claim, it might be possible to resolve the issue by filing an online or paper Claim Reconsideration Form in which your health care provider corrects errors or supplies the required documentation. If this doesn't work, or if the denial pertains to another issue, you'll need to file a written request for an internal appeal.
Information and Format Requirements
An appeal letter is a written request to reconsider a prior-authorization or post-service denial. It must include a statement as to why you believe the denial was incorrect, as well as all relevant facts. Supporting documents -- such as a copy of the Explanation of Benefits denial letter, medical records, medical review sheets, payment receipts and correspondence -- also are required.
Although you have the option to write an appeal letter from scratch or use an online template, missing or incomplete information could lead to your request being rejected. An alternative is to use the appeal request form that UnitedHealthcare provides.
Follow instructions on the Explanation of Benefits denial letter telling you where to mail the appeal. Send it via certified mail with a return receipt request.
UnitedHealthcare follows a "whichever is later" time frame for filing an appeal letter. File your appeal:
- No later than 12 months from the date of services, or
- 12 months after the date of eligibility posting, or
- Within 60 days after the payment, denial or recoupment of a timely claim submission, whichever is later
You'll get a decision within 30 days from the receipt of the letter unless the review team needs extra time to investigate your appeal. If it does, you'll receive a letter telling you when to expect a decision.