How to appeal a denial from UnitedHealthcare

UPDATED JULY 2026 · U.S. PLANS · NOT LEGAL OR MEDICAL ADVICE

UnitedHealthcare (part of UnitedHealth Group) is the largest health insurer in the U.S., covering employer plans, ACA marketplace plans, Medicare Advantage, and Medicaid plans. Because the book of business is so broad, the exact appeal route depends on which UnitedHealthcare entity issued your denial — the letter itself names it.

How appeals work at UnitedHealthcare

• Check the top of your denial letter for the exact entity: many employer plans are administered by UMR (a UnitedHealthcare company) or reference Optum entities — your appeal goes to whichever administrator issued the letter.
• Most members can submit an appeal online through the member portal (look for the claims detail, then the appeal option), or by mail to the address in the letter's appeal-rights section.
• Pharmacy denials usually run through Optum Rx and have their own exception/appeal track — the drug denial notice states it.
• For prior-authorization denials, your doctor can request a peer-to-peer review with a UnitedHealthcare medical director — often the fastest lever before or alongside a written appeal.
• Keep the claim number and the reference/case number from the letter on everything you send.

The deadlines that apply to nearly every UHC plan

• At least 180 days to file the internal appeal from the date on the denial notice (non-grandfathered plans; the date printed on your letter controls).
• The plan must decide within about 30 days for care you haven't received yet, and about 60 days for care already received.
• Urgent case? Ask for an expedited appeal — a decision in roughly 72 hours when a physician confirms that waiting endangers your health.
• After the final internal denial: you can request independent external review — generally within about 4 months, per your letter.
• Employer self-funded plan? ERISA rules apply: state programs and regulators generally don't, and external review runs through the federal process. Your letter or HR can confirm the funding type.

Federal sources: HealthCare.gov internal appeals and HealthCare.gov external review. Your denial notice and plan documents control when they differ.

Best next reads: Prior authorization denials and “Not medically necessary” denials — and decode any codes on the letter in the denial-code library.

Common questions

My letter says UMR or Optum, not UnitedHealthcare — where do I appeal?

To the entity on the letter. UMR and Optum are UnitedHealth Group companies that administer many employer plans; the appeal-rights section of the letter names the correct address and portal. The federal appeal rules and deadlines are the same.

Can my doctor talk to UnitedHealthcare directly about a prior-auth denial?

Yes — ask your doctor's office to request a peer-to-peer review with the plan's medical director. It's often faster than a written appeal and doesn't use up your formal appeal rights.