UnitedHealthcare

Appeal Deadlines

Commercial: 65 calendar days from denial date

Medicare: 60 days for Medicare Advantage

Key Facts

• +UHC has the shortest commercial appeal deadline among major insurers at 65 days. Aetna, BCBS, and Cigna allow 180 days. Missing this window forfeits your appeal right permanently.
• +Medical necessity denials must reference UHC's Coverage Determination Guidelines (CDGs), which are publicly searchable at UHCProvider.com. Generic appeals without CDG citations are the most common reason well-documented appeals still fail.
• +82% of prior authorization appeals succeed when a peer-to-peer review with the UHC reviewing physician is requested, per AMA 2024 survey data.
• +UHC was ranked by physicians as the insurer with the highest prior authorization burden, with 72% of physicians rating it high or extremely high burden.
• +UHC's Medicare Advantage prior auth denial rate is 12.8% -- the highest among major MA insurers.

What to Watch

• +The 65-day appeal deadline is the most important thing to track. Mark the deadline immediately when you receive a denial.
• +UHC used NaviHealth's nH Predict algorithm for Medicare Advantage post-acute care decisions. If you are in Medicare Advantage and were denied skilled nursing or inpatient rehab, this algorithm may have driven the denial.
• +UHC's SNF denial rate increased ninefold between 2019 and 2022, per a U.S. Senate investigation report released in October 2024.

Appeal Tips

1. File your appeal within 30 days of the denial to give yourself room before the 65-day deadline.
2. Look up the specific CDG that applies to your denied service at UHCProvider.com before writing your appeal.
3. Request a peer-to-peer review between your physician and the UHC reviewing physician. The success rate is significantly higher than written appeals alone.
4. For Medicare Advantage denials of post-acute care, specifically reference the Senate investigation report and request that a clinician -- not an algorithm -- review your case.

Resources

• UHC Coverage Determination Guidelines
• UHC Member Appeals