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January 1, 2022 at 7:00 AM CT

Applicable to all states except North Carolina

Member rights and responsibilities - Chapter 16, 2022 UnitedHealthcare Administrative Guide

Our members have certain rights and responsibilities to help uphold the quality of care and services they receive from you. We list the rights and responsibilities in the member materials for commercial and MA benefit plans.

Member appeals and grievance complaints

Members have the right to appeal the determination of any denied services or claims by filing an appeal. Time frames for filing an appeal vary depending on applicable state or federal requirements.

We maintain a system of logging, tracking and analyzing appeals and grievance issues received from members and health care providers consistent with state and federal regulatory requirements. We use the information to measure and improve member and health care provider satisfaction. This system helps us fulfill the requirements and expectations of our members and our network providers. In addition, it supports compliance with the Centers for Medicare & Medicaid Services (CMS), the National Committee for Quality Assurance (NCQA), The Joint Commission, and other accrediting and/or regulatory requirements.

Member’s request for confidentiality

The state and federal government allows an individual, other than the subscriber, to request confidential treatment as it relates to the following:

  • Referrals
  • Authorizations
  • Denials
  • Claims payments

We require our members to submit written requests for confidential status to you. The request must include their current address, private phone number, and date and time you received it. Having a written request prevents disagreements regarding the accuracy of their personal contact information. Members are responsible for resubmitting new confidentiality forms if their information changes.

Privacy regulations

HIPAA privacy regulations provide federal protection for the privacy of health care information. These regulations control the internal and external uses of health information. They also create certain individual patient rights. Information related to our privacy practices can be found on uhc.com > Privacy.

Advance directives

The federal Patient Self-Determination Act (PSDA) gives patients the legal right to make choices about their medical care prior to a severe illness or injury through an advance directive. Under the federal act, health care providers and facilities must:

  • Not discriminate against an individual based on whether or not the individual has executed an advance directive.
  • Document in a prominent part of the individual’s current medical record whether or not the individual has executed an advance directive.
  • Educate its staff about its policies and procedures for advance directives.
  • Provide for community education regarding advance directives.
  • Give patients written information on state laws about advance treatment directives, patients’ rights to accept or refuse treatment, and their own policies regarding advance directives.

We also inform members about state laws on advance directives through our member’s benefit material. We encourage these discussions with our members.

Information is also available from the Robert Wood Foundation, Five Wishes. The information there meets the legal requirements for an advance directive in certain states and may be helpful to members. Five Wishes is available on AgingWithDignity.org.