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Pre-Service Appeals - Chapter 6, 2020 UnitedHealthcare Administrative Guide

Pre-Service Appeals

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

Expedited or Urgent Appeals

If you have already provided the service, an expedited or urgent appeal is not available. Submit a claim 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 time frame 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.