UnitedHealthcare denied prior authorization? Here’s what to do
Summary: A UnitedHealthcare prior-authorization denial can usually be appealed with a letter of medical necessity from your doctor — and an expedited appeal if your health is at risk.
Why UnitedHealthcare denied prior authorization
- The request lacked a letter of medical necessity or clinical notes.
- UnitedHealthcare considers the service experimental or not medically necessary.
- A formulary or step-therapy rule required trying another option first.
- The request used the wrong code or was missing supporting records.
Step by step: what to do
- Call UnitedHealthcare at 1-866-414-1959 and get the precise reason for the prior-auth denial.
- Ask your prescriber to submit a letter of medical necessity with clinical notes.
- Request a peer-to-peer review between your doctor and the UnitedHealthcare medical director.
- File a written appeal through the appeal address on your denial letter or the myuhc.com member portal before the 180 days from the date of the denial deadline.
- If your health is at risk, request an expedited (urgent) appeal.
Common mistakes to avoid
- Waiting on the doctor’s office instead of driving the appeal yourself.
- Skipping the peer-to-peer review, which often resolves the denial fastest.
- Not requesting an expedited appeal when the delay could harm your health.
What to say when you call UnitedHealthcare
- I’m appealing a prior-authorization denial and want to schedule a peer-to-peer review.
- Please tell me exactly what clinical documentation is missing.
- If this is time-sensitive, I’m requesting an expedited appeal.
Know your rights
You have the right to a written explanation of any denial, to a full copy of your plan documents, and to appeal — first internally, then through an independent external review.
Regulator: your state Department of Insurance (and the federal No Surprises Act). If the internal appeal fails, request an external review and file a complaint with your state Department of Insurance.
Don’t sit through UnitedHealthcare’s phone menu
Karen calls UnitedHealthcare at 1-866-414-1959, works through the phone tree, and waits on hold for you. Once she reaches a human representative, she adds you to the call.
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Frequently asked questions
What is a peer-to-peer review?
It is a call between your treating doctor and a UnitedHealthcare medical director to reconsider the prior-authorization denial. It often resolves denials faster than a written appeal alone.
How fast is an expedited appeal?
When a delay could seriously jeopardize your health, plans must decide an expedited appeal much faster than a standard one — often within 72 hours.