Denied by UnitedHealthcare or Optum? As the largest US insurer serving 49 million members, UHC faces strict CMS and ERISA oversight. ClaimBack writes your professional appeal letter in 3 minutes.
Check My Claim Free →Takes 3 minutes · No login required · ERISA-ready letters
UnitedHealthcare is the largest US health insurer, covering 49 million members. Federal law gives you powerful appeal rights — and UHC has faced significant regulatory scrutiny over its denial practices.
UnitedHealthcare's Medicare Advantage plans are directly regulated by the Centers for Medicare & Medicaid Services (CMS). CMS has authority to audit UHC's coverage decisions, issue civil monetary penalties, and require corrective action plans. Recent CMS audits have found UHC improperly denied Medicare Advantage claims that should have been covered under Original Medicare standards.
If your UHC coverage comes through your employer, ERISA applies. You have the right to a full and fair review, a written denial with specific reasons and the clinical criteria applied, and the right to appeal to an independent external reviewer. ERISA also allows you to sue for benefits in federal court if UHC wrongfully denies your claim after exhausting internal appeals.
UHC must decide standard pre-service appeals within 30 days and post-service (paid claim) appeals within 60 days. Urgent care appeals — where a delay could seriously jeopardize your health — must be decided within 72 hours. UHC must acknowledge your appeal in writing. If UHC misses these deadlines, the claim is deemed denied and you can immediately request external review.
After completing UHC's internal appeal process, you have the right to request independent external review through a CMS-approved Independent Review Organization (IRO). The external reviewer's decision is binding on UHC. For Medicare Advantage plans, you can also escalate to the Quality Improvement Organization (QIO) for a rapid review of urgent coverage denials.
Three steps. No jargon. No legal degree required.
ClaimBack provides AI-assisted document drafting. We are not a law firm and do not provide legal advice.