Insurer record · Medicare Advantage · 75 contracts · marketplace plans in 19 states

UnitedHealth Group

12.8%

of MA prior-authorization requests denied in 2024 — the highest of any major insurer

Dataset: Prior-authorization denials · Medicare Advantage

Detailed file hard to check See the public-record check →

The bottom line

UnitedHealth denied Medicare Advantage prior-authorization requests at the highest rate of any major insurer in 2024. Its public summary pages advertise a 95.4% approval rate — a figure that excludes drugs, post-acute care transitions, and delegated providers, and counts auto-approvals issued in real time. Its contract-level file tells a different story: a ten-fold spread between contracts, from 2.3 percent denied to 22.8 percent. Which contract you are in decides what gets approved — and the file that shows it is engineered to resist archiving.

How to use this: Compare the same plan type, ask the insurer about the pattern, or identify a question for reporting, research, or oversight.
What it cannot prove: This aggregate record does not decide whether your individual denial was correct. Your notice, plan rules, and clinical facts still control your appeal.

From the payer’s own CY2025 posting

What UnitedHealth Group disclosed

Measure	What the insurer reported	Note
Standard PA requests, 75 MA contracts (file, Jan–Jun 2025)	4,617,893
Denied (same file)	14.2%	654,841 requests
Published CY2025 MA approval rate (web summary)	95.4%	broad exclusions; ~50% auto-approved in real time
ACA marketplace approval rate (web summary)	80.3%
Lowest-denial contract (H0543)	2.3%
Highest-denial contract (H0294)	22.8%
Contract-level file access	Blocks archival tools

Source · UnitedHealthcare CMS interoperability pages (full CY2025 summary metrics)

Published: 2026
Source note: Rates carry broad exclusions (drugs, post-acute transitions, delegated providers); contract-level PDF blocks archival tools.
How to check it: The original public source is linked below. We label the market, year, and known limits beside the number.

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Appeal drafting · free to use

Denied by UnitedHealth Group? Build a fact-specific draft.

Start with the facts in your notice. The builder adds public context only when it matches Medicare Advantage prior authorization, and labels that context so it is not confused with evidence about your individual request.

Write my appeal letter

The block below is for Medicare Advantage prior-authorization appeals only.

I ask that my Medicare Advantage prior-authorization appeal be reviewed carefully. I include the following public figures as background only; they do not describe my individual request and do not, by themselves, show that this denial was incorrect: - KFF's analysis of insurer-reported CMS data found that 80.7% of appealed Medicare Advantage prior-authorization denials were overturned in 2024. CMS does not audit these insurer submissions (https://www.kff.org/medicare/medicare-advantage-insurers-made-nearly-53-million-prior-authorization-determinations-in-2024/). - UnitedHealthcare’s partial contract-level file covering 75 Medicare Advantage contracts from January through June 2025 reports a 14.2% prior-authorization denial rate. The file is not a full-year result and may not cover this member’s contract. (https://www.uhc.com/legal/cms-interoperability-prior-authorization). Please reconsider my individual request on its facts, provide the specific criteria used, and identify the credentials of any clinician who reviewed it.

On the record

The Senate found post-acute denials tripled.

The Senate Permanent Subcommittee on Investigations reported UnitedHealthcare's prior-authorization denial rate for post-acute care rose from 10.9% in 2020 to 16.3% in 2021 to 22.7% in 2022, while the company explored machine learning to predict which denials would be appealed.

Source · U.S. Senate Permanent Subcommittee on Investigations, majority staff report

Published: Oct. 17, 2024
How to check it: The original public source is linked below. We label the market, year, and known limits beside the number.

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The nH Predict lawsuit. ALLEGATION

A pending class action alleges UnitedHealth's nH Predict algorithm carried a 90% error rate and that the company knew only about 0.2% of policyholders would appeal. These are allegations from the complaint, not court findings; in 2025 the court ordered discovery on the algorithm.

Source · Estate of Gene B. Lokken v. UnitedHealth Group, class-action complaint (allegations)

Published: Nov. 14, 2023
Source note: Allegations, not findings.
How to check it: The original public source is linked below. We label the market, year, and known limits beside the number.

Open original source ↗

See how these figures are collected, what they can and cannot tell you, and how to request a correction on the methodology page. Compare payers on the rankings page.