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UnitedHealthcare: Medicare Advantage denial & appeal rates

UnitedHealth Group / UnitedHealthcare · 26% of MA enrollment

PA denial rate
12.6%
Denials appealed
12.0%
Overturned on appeal
78.8%
MA enrollees
9.3M

In 2024, UnitedHealthcare denied about 12.6% of the prior-authorization requests it reviewed. When members appealed, 78.8% of those denials were overturned — yet only 12.0% of denials were appealed at all. ~81% of appealed MA prior-authorization denials are overturned, so a denial is rarely the final word.

UnitedHealthcare’s posted coverage policies

Insurers must post the medical policies they use to decide coverage. These are the ones most relevant to lab, imaging, and facility denials — quote the matching policy in your appeal.

Service categoryPolicyUpdated
Advanced imaging (MRI/CT)Radiologic Diagnostic Procedures - MA Medical Policy06.01.2026 (Last Published)
PET / oncologic imagingPositron Emission Tomography (PET)/Combined PET-CTnot confirmed
Skilled nursing facility (SNF)Skilled Nursing Facility, Rehabilitation, and Long-Term Acute Care Hospitalnot confirmed
Inpatient rehab facility (IRF)Skilled Nursing Facility, Rehabilitation, and Long-Term Acute Care Hospitalnot confirmed
Home healthHome Health Services, Home Health Visits, Respite Carenot confirmed
DME (general)Durable Medical Equipment (DME), Prosthetics, Appliances, Nutritional Supplies Gridnot confirmed
CPAP/PAP & suppliesRespiratory Services and Equipmentnot confirmed
Oxygen / respiratoryOxygen (Home Use)not confirmed
Spine surgery / fusionSpine Procedures - MA Medical Policy07.01.2026 (index) / 06.22.2026 (PDF metadata)
Epidural / facet injectionsPain Management06.01.2026 (Last Published)
Cataract surgeryVision Services (cataract sits here)not confirmed
Anti-VEGF / intravitreal (Eylea/Avastin)Medicare Part B Step Therapy Programsnot confirmed
Behavioral health / inpatient psychMental Health Services and Proceduresnot confirmed
Skin substitutes / CTPsSkin Substitutes Grafts/Cellular and Tissue-Based Products (Injections and/or Applications) - MA Medical Policy06.01.2026 (index) / 05.29.2026 (PDF metadata)
Oncology / chemotherapy drugsMedications/Drugs (Outpatient/Part B)07.01.2026 (Last Published)
Knee / hip arthroplastyJoint Procedures - MA Medical Policy06.01.2026 (Last Published)
Bariatric surgeryTreatment of Obesity, Non-Surgical and Surgical (Bariatric Surgery)not confirmed
Sleep studiesSleep Apnea Diagnosis and Treatmentnot confirmed
Genetic / molecular testingMolecular Pathology/Molecular Diagnostics/Genetic Testing06.01.2026 (Last Published)
HospiceHospice Servicesnot confirmed

UnitedHealthcare’s CMS prior-authorization metrics posting →

Denied by UnitedHealthcare? Don’t pay a bill you may not owe.

Appeals win far more often than people expect. See how the deadlines and the process work, or fast-track a rehab/nursing discharge.

Insurer / contract level. Medicare does not publish per-plan denial rates. Rates are 2024 prior-authorization determinations; data as of July 2026. Notes: Highest denial rate of the 6 firms. KFF PROSE/chart-title cite 12.8% denial (vs 12.6% in chart dataset) - flagged. CY2025 posting rollup: 97.5% of medical claims need no PA; 95.4% of PAs approved incl. after appeals; ~24hr avg (MA+DSNP). Informational only — not medical, legal, or billing advice.