How does Counterclaim generate an insurance appeal letter?

Counterclaim uses a 5-agent AI pipeline. The Reader extracts claim data from your document. The Researcher identifies applicable state insurance law. The Writer drafts a formal appeal letter. The Adversary identifies weaknesses. The Editor rewrites the letter to eliminate all weaknesses. The final letter is ready to print and mail in minutes.

Is Counterclaim free to use?

Yes - Counterclaim is free during the launch period. Upload your denial letter and receive a complete adversary-tested appeal letter at no cost. No account required.

What types of insurance denials can Counterclaim handle?

Counterclaim handles all major denial types: medical necessity (CO-50), prior authorization (CO-11), experimental treatment (PR-1), fee schedule (CO-45), timely filing (PR-27), not covered (CO-4), step therapy (PR-50), and missing information (CO-16).

What file formats does Counterclaim accept?

Counterclaim accepts PDF files, JPG and PNG photos, and scanned documents of your denial letter or Explanation of Benefits (EOB).

Does Counterclaim provide legal advice?

No. Counterclaim generates appeal letters based on publicly available legal and clinical information but does not constitute legal advice. For complex cases, consult a licensed healthcare attorney or certified patient advocate.

How do I file an appeal with UnitedHealthcare?

File a written appeal within 180 days of the denial notice. Send it to the appeals address listed on the back of your member ID card or on the EOB - addresses vary by plan, so use the one your specific denial provides. Include your member ID, the claim or authorization number, the specific UHC clinical policy you're contesting, and supporting clinical documentation.

Can I escalate a UnitedHealthcare appeal to external review?

Yes. After exhausting UHC's internal appeals (typically one or two levels depending on plan), you have the right to an external review. For ACA-regulated plans this is conducted by an Independent Review Organization at no cost to you. For self-funded ERISA plans you can request an IRO through the plan administrator.

Does UnitedHealthcare review urgent appeals faster?

Yes. Under federal law (45 CFR section 147.136) and UHC's own policy, expedited appeals must be decided within 72 hours when the standard timeline would seriously jeopardize your life, health, or ability to regain maximum function. Mark your appeal as 'expedited' or 'urgent' and have your physician confirm clinical urgency in writing.

What if Optum or eviCore - not UnitedHealthcare directly - denied my prior authorization?

Optum and eviCore make initial determinations under contract with UHC, but the appeal still flows through UHC. Address the appeal to UnitedHealthcare's appeals unit; they are responsible for the final determination and they own the legal relationship with you under your plan.

Can I appeal a UnitedHealthcare Medicare Advantage denial the same way?

No. Medicare Advantage appeals follow CMS rules. After UHC's internal reconsideration, your appeal is automatically sent to MAXIMUS Federal Services as the Medicare Advantage Independent Review Entity (IRE), then to an Administrative Law Judge if it remains denied. Counterclaim drafts a letter that respects this distinct path when you indicate it's a Medicare Advantage plan.

What documents should I include with my UHC appeal?

At minimum: a copy of the denial notice or EOB, a physician letter of medical necessity quoting the specific UHC policy section, peer-reviewed clinical evidence supporting the requested service for your diagnosis, the relevant medical records (office notes, imaging, labs), and a written request for the appeal to be reviewed by a board-certified specialist in the relevant clinical area.

How do I know whether my UHC plan is fully insured or self-funded ERISA?

Check the front of your member ID card and the Summary of Benefits and Coverage. Self-funded plans typically say 'plan administrator' or list the employer as the plan sponsor, and the EOB will reference ERISA. Fully insured plans are regulated by your state department of insurance. The distinction matters because external review for self-funded plans goes through an IRO selected by the plan administrator rather than the state.

Did the 2024 Change Healthcare cyberattack affect my UHC appeal?

The Change Healthcare cyberattack disclosed in February 2024 disrupted claims processing and prior-authorization workflows nationwide for several weeks. If your denial was issued during that disruption, the appeal record should note the operational context, particularly if procedural notice timeliness or supporting-documentation availability was affected. The substantive coverage determination is still appealable on the merits.

What clinical evidence does UnitedHealthcare give the most weight?

UHC's Medical Policies and Coverage Determination Guidelines explicitly reference peer-reviewed clinical literature, FDA labeling, specialty-society guidelines (NCCN for oncology, AAOS for orthopedics, ACOG for OB/GYN, AAP for pediatrics, etc.), and published systematic reviews. An appeal that quotes the relevant specialty-society guideline by name and section, attaches the underlying study, and demonstrates how the patient's case fits the guideline criteria has a substantially better procedural footing than a general medical-necessity argument.

UnitedHealthcare

UnitedHealthcare Denial Appeal - Free AI Letter Generator | Counterclaim

Upload your UnitedHealthcare denial notice or EOB. Our 5-agent AI pipeline drafts a formal appeal that quotes UnitedHealthcare's own clinical coverage policy back to them and cites your state's external-review law.

UnitedHealthcare is the health-benefits arm of UnitedHealth Group, the largest US healthcare conglomerate by revenue. UnitedHealthcare administers commercial group plans for employers of every size, individual ACA Marketplace coverage in many states, Medicare Advantage and Medicare Supplement plans (UHC is the largest Medicare Advantage carrier in the US by enrollment), and Medicaid managed-care contracts in roughly 30 states under brands such as UnitedHealthcare Community Plan. Critically for appeals, UHC delegates large slices of its prior-authorization and clinical-review work to sister companies inside the UnitedHealth Group umbrella - Optum (which now owns eviCore as well as a national network of physician practices), OptumRx (pharmacy benefit management), and Naviguard (out-of-network pricing). When a UHC denial says "reviewed by Optum" or "per eviCore criteria," you are still appealing UnitedHealthcare under your plan contract, but the underlying clinical guideline came from a vendor that applies its own proprietary criteria.

UnitedHealthcare at a glance

Members served: Roughly 50 million US members served across commercial, Medicare Advantage, Medicaid, and individual plans (per UnitedHealth Group 10-K filings).
Headquarters: Minnetonka, Minnesota
Internal appeal deadline: 180 days from the date on the denial notice for most commercial plans; 60 days for Medicare Advantage reconsiderations.
Decision timeline: Standard: 30 days for pre-service, 60 days for post-service (commercial); 30 days pre-service / 60 days payment (Medicare Advantage). Expedited: 72 hours for urgent / expedited appeals.
External review: State-administered IRO for fully insured plans; member-selected Independent Review Organization for self-funded ERISA plans; MAXIMUS Federal Services for Medicare Advantage Level 2.
Parent company / structure: UnitedHealth Group · Commercial group, Medicare Advantage, Medicaid managed care, and individual ACA Marketplace coverage.

Common UnitedHealthcare denial patterns

These are the denial patterns we see most often from UnitedHealthcare members based on publicly-reported insurer policies and regulator findings. The right appeal approach depends on which pattern matches your denial.

Prior-authorization denials for advanced imaging (MRI, CT, PET) and specialty drugs - UHC delegates these reviews to Optum and eviCore that apply tighter criteria than the underlying plan
Medical-necessity denials citing UHC's internal Medical Policies and Coverage Determination Guidelines
Out-of-network denials where UHC has determined an in-network alternative was available
Step-therapy / fail-first denials on specialty pharmacy drugs administered by OptumRx
Post-service denials based on UHC's interpretation of CPT / HCPCS coding
Skilled nursing facility and home-health denials in Medicare Advantage members - the OIG has flagged this category as a frequent overturn-on-appeal area
Behavioral-health denials administered through Optum Behavioral Health - subject to MHPAEA parity scrutiny

How UnitedHealthcare's appeal process works

UnitedHealthcare gives most members 180 days from the date on the denial notice to file an internal appeal. You may have one or two levels of internal appeal depending on your plan, after which you can request external review through your state's process or, for self-funded ERISA plans, through an Independent Review Organization. UHC accepts appeals by mail, fax, or through the member portal at myuhc.com. Expedited (urgent) appeals are decided within 72 hours when the standard timeline would jeopardize your health.

Step 1: Read the denial. Identify the specific UHC Medical Policy or Coverage Determination Guideline cited (these have policy numbers and are published at uhcprovider.com), and check whether the actual reviewer was UHC, Optum, eviCore, or OptumRx. Step 2: Mark the deadline. Standard internal appeal must be filed within 180 days of the date on the denial notice. Step 3: Submit the appeal in writing - either upload through myuhc.com, fax to the number on the denial, or mail to the appeals address printed on the EOB (these vary by plan, so do not invent one). Step 4: Include a physician letter of medical necessity quoting the specific UHC policy section and explaining how your case meets it, plus the relevant clinical evidence. Step 5: Mark the appeal expedited if delay would jeopardize your health, and have your physician confirm urgency in writing - UHC must then decide within 72 hours under federal rule. Step 6: If the internal appeal is denied (or upheld at level 1 with a level-2 option), file the second internal level if available. Step 7: After internal exhaustion, request external review through your state's process for fully insured plans, or through an Independent Review Organization for self-funded ERISA plans. Step 8: For Medicare Advantage members, the appeal automatically forwards to MAXIMUS Federal Services as the CMS Independent Review Entity if UHC denies the reconsideration.

What makes UnitedHealthcare appeals succeed

Three things consistently strengthen UnitedHealthcare appeals. First, identify and quote the exact UHC Medical Policy, Coverage Determination Guideline, or Optum / eviCore criterion the denial relied on - these are public documents and the appeal review is far more rigorous when the patient demonstrates the policy was misapplied. Second, address the right entity: when the underlying review came from Optum or eviCore, the appeal still flows through UHC, so the letter should acknowledge both the vendor's role and UHC's contractual responsibility under your plan. Third, route correctly by product line - commercial / ASO follows ERISA timelines, Medicare Advantage follows the CMS reconsideration / IRE / ALJ ladder, Medicaid managed-care follows the state Medicaid agency's appeal and fair-hearing rules, and Marketplace follows ACA timelines with state external review. Sending a Medicare Advantage member's reconsideration to the commercial appeals address is a common reason for delay or procedural denial.

Recent regulatory and public-record context

UnitedHealthcare's prior-authorization practices have drawn sustained federal scrutiny. The Senate Permanent Subcommittee on Investigations issued an October 2024 report finding that UnitedHealthcare, Humana, and CVS / Aetna disproportionately denied Medicare Advantage post-acute-care prior authorizations between 2019 and 2022. The HHS Office of Inspector General's prior April 2022 audit found that 13 percent of MA prior-authorization denials by major plans (including UHC) met traditional Medicare coverage rules and should not have been denied. UnitedHealth Group also disclosed the 2024 Change Healthcare cyberattack, which disrupted claims processing and prior-authorization workflows nationwide for weeks. None of these items appears on a denial notice, but they are part of the public record and provide context for why a thorough, well-documented appeal is appropriate.

Where to mail your UnitedHealthcare appeal

UnitedHealthcare does not publish a single national appeals address. Routing depends on your specific plan, product, or state. Use the address printed on your denial notice or on the back of your member ID card. The official appeals page is linked below.

Official UnitedHealthcare appeals page

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Frequently asked questions: UnitedHealthcare appeals

Denial codes most relevant to UnitedHealthcare

Prior Authorization Denial (CO-11)

Medical Necessity Denial (CO-50)

Step Therapy Denial (PR-50)

Out-of-Network Provider Denial (CO-97)

Experimental Treatment Denial (CO-55)

States with notable UnitedHealthcare membership

Other insurer appeal guides

Appeal a Anthem denial

Appeal a Aetna denial

Appeal a Cigna denial

Appeal a Humana denial

Appeal a Kaiser Permanente denial

Appeal a Blue Cross Blue Shield denial