UnitedHealthcare

Contract: H0028 · Plan type: HMO

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Evidence lead: Top-three record · Large request-volume cohort

UnitedHealthcare: One of the ten largest authorization workloads

The 2,100,000 recorded requests place this contract in the highest-volume tier. Its request-volume rank is #1 of 37. Volume shows the denominator behind approvals and denials; it is not a measure of plan quality, membership, benefit breadth, price, or future coverage decisions.

Top-three record · Large request-volume cohort

One of the ten largest authorization workloads

The 2,100,000 recorded requests place this contract in the highest-volume tier. Its request-volume rank is #1 of 37. Volume shows the denominator behind approvals and denials; it is not a measure of plan quality, membership, benefit breadth, price, or future coverage decisions.

Ranks eleven through fifteen · Upper-middle appeal uptake

Appeal filing exceeded most contract records

The 19,845 filed appeals represent 15.0% of denied requests. That is rank #11 of 37 for filing share. The ratio reports aggregate activity; it cannot reveal why an appeal was or was not filed, whether the underlying cases were comparable, or what happened outside the reporting window.

Ranks twenty-one through twenty-five · Lower-middle denial cohort

Below the center of the denial-rate ordering

At 6.3%, this contract sits in the lower-middle part of the observed distribution. The exact rank is #24 of 37. This is aggregate prior-authorization activity for the reporting window, not a probability that a particular service, drug, or beneficiary request will be denied.

Ranks eleven through fifteen · Upper-middle overturn cohort

Appeal overturns ran above most contracts

The observed overturn rate is 72.0%, in the upper-middle portion of the table. Its overturn-rate rank is #15 of 37. The denominator is filed appeals, not all authorization requests. The percentage therefore describes reviewed appeals and must not be read as an individual outcome forecast.

Ranks eleven through fifteen · Upper-middle reversal reach

Reversals covered an above-median share of denials

Overturned appeals represent 10.8% of all denials here, based on 14,288 reversals. The cross-contract rank is #15 of 37. This derived measure combines appeal filing and outcome, so it supplies scale context but does not identify clinical reasons, administrative errors, or coverage rules.

Prior Authorization Scorecard

PA Requests
2,100,000
PA Denial Rate
6.3%
Appeals Filed
19,845
Appeal Overturn Rate
72.0%

Detailed Metrics

Metric Value
Prior Authorization Requests 2,100,000
PA Approved 1,967,700
PA Denied 132,300
Appeals Filed 19,845
Appeals Overturned 14,288
Source: CMS Office of Inspector General report OEI-09-22-00380; KFF 2023 Medicare Advantage analysis. Verify with HHS OIG → · CMS.gov →
Sources, caveats, and related notes for UnitedHealthcare
What does UnitedHealthcare's overturn rate mean? Of the appeals filed after denials in this source record, 72% were overturned (14,288 of 19,845 filed appeals, not all 132,300 denied requests).
This data is for informational purposes only and does not constitute medical, financial, or insurance advice. Contact CMS or your plan for coverage decisions. Data from CMS OIG and KFF Medicare Advantage analysis.

Data: CMS OIG OEI-09-22-00380 and KFF 2023 Medicare Advantage analysis. Not affiliated with CMS. ← All MA plans

Read our methodology - how this data is sourced, computed, and verified.

Primary data: U.S. Department of Health & Human Services, Office of Inspector General, Medicare Advantage Encounter Data (Report OEI-09-22-00380, 2024). Secondary data: Kaiser Family Foundation 2023 Medicare Advantage Prior Authorization analysis. Methodology and editorial review by PlainInsurer, see methodology.