Pre-Service Appeals - Chapter 6, 2018 UnitedHealthcare Administrative Guide

A pre-service appeal is a request to change a denial of coverage for a planned healthcare service. The member’s rights in the member’s benefit plan govern this process.

You can submit normal pre-service appeal requests through the standard fax line or mailed to the address in the pre-service denial letter.

Expedited or Urgent Appeals

If you have already provided the service, an urgent appeal is not available.

You may request an urgent pre-service appeal on behalf of the member by using the urgent appeals fax number listed in the pre-service denial letter. We consider requests urgent when:

  • The standard review timeframe risks the life or health of the member 
  • The member’s ability to regain maximum function is jeopardized
  • The member’s severe pain is not able to be managed without the care or treatment requested

Refer to the UnitedHealthcare Commercial Clinical Pre-Service Expedited or Urgent Appeals Process Frequently Asked Questions document using the ‘Search’ box on UHCprovider.com for additional information and a list of fax numbers by benefit plan.