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. A peer-to-peer review is highly recommended before you file a pre-service appeal.
Expedited or Urgent Appeals
If you have already provided the service, an expedited or urgent appeal is not available. A claim should be submitted based on the service provided. See the appeal section for more information.
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.