UnitedHealth Denied 32% of Claims in 2023. Here Is What You Can Do About It.

 UnitedHealth Group denied 32% of all claims submitted by physicians in 2023. That same year, the company's CEO received $23 million in compensation. These are not opinions. They come from UnitedHealth's own annual report and SEC executive compensation filings.


If you received a denial letter from your health insurance company, you are not alone. Tens of millions of Americans receive denied claims every year. What most people do not know is that they have the legal right to appeal — and those appeals succeed more often than the insurance companies want you to believe.


Here is exactly what to do.


**Step 1: Read the denial letter carefully**


Every denial letter must state the specific reason your claim was denied. Common reasons include: not medically necessary, out-of-network provider, prior authorization not obtained, experimental or investigational treatment, or administrative error. The reason matters because your appeal strategy depends on it.


**Step 2: Request your explanation of benefits**


Your Explanation of Benefits (EOB) is the detailed document showing exactly how your claim was processed. If you don't have it, call the number on your insurance card and request it in writing. You have a legal right to this document.


**Step 3: File an internal appeal**


Under the Affordable Care Act, all health insurance plans must provide at least one internal appeal process. You have 180 days from receiving the denial to file an internal appeal. Write a letter that includes: your policy number, the claim number, the date of service, the specific reason you believe the denial was incorrect, and any supporting documentation from your doctor.


If your denial was for "not medically necessary," your physician needs to write a letter explaining the medical necessity in specific clinical terms. Insurance companies' medical reviewers respond to clinical language. Generic letters rarely succeed.


**Step 4: Request an expedited appeal for urgent situations**


If your situation is urgent — meaning your health could be seriously harmed by waiting — you have the right to an expedited appeal, which the insurer must resolve within 72 hours.


**Step 5: File an external appeal**


If your internal appeal is denied, you have the right to an external appeal with an independent review organization. Under the ACA, external appeals are binding — the insurance company must accept the result. Studies show that external appeals succeed for patients approximately 40% of the time.


**Step 6: File a complaint with your state insurance commissioner**


Every state has an insurance commissioner whose job is to regulate insurance companies operating in that state. A complaint creates a documented record and sometimes produces faster resolution than the formal appeals process. Find your state commissioner at the National Association of Insurance Commissioners website.


**Step 7: Contact your employer's HR department**


If your insurance is employer-sponsored, your employer has a financial interest in your claim being resolved. HR departments sometimes have direct lines to insurance company account managers that bypass the general customer service system.


**What the data shows**


A 2023 KFF (Kaiser Family Foundation) study found that 83% of internal appeals filed with marketplace insurers succeeded. The problem is that fewer than 1% of denied claims are ever appealed. Insurance companies count on you not appealing. Every time you do appeal, you are exercising a right that was hard won and that the industry would prefer you forget you have.


The system is designed to exhaust you. Document everything. Date every call. Get names. Send letters certified mail. You have more rights than they want you to know about.


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