Administrative or processing issue
- Corrected-claim history
- Proof of earlier submission
- Eligibility records
- Authorization records
- Referral records
Documents Checklist
Documents to Gather for a UnitedHealthcare Appeal
Start with the documents below, then add what's relevant to your specific denial. Not every appeal needs every item.
UnitedHealthcare Appeal Documents Checklist
remedy.support/denials/unitedhealthcare/documents-checklist/
Start With These Documents
Foundational Documents
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Complete denial notice
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Complete Explanation of Benefits
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Both sides of your insurance card
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Relevant claim and service information
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The appeal instructions from your notice
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Correspondence with the carrier
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Correspondence with your provider
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Your Summary Plan Description, if available
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Applicable representative authorization
Depending on the Denial
Add What's Relevant to Your Case
Medical-necessity issue
- Provider rationale
- Relevant clinical records
- Treatment history
- A letter of medical necessity
- The clinical policy cited in the denial
- Peer-reviewed evidence, only when appropriate and provider-supported
Out-of-network or access issue
- Network-directory records
- Call logs
- Provider availability information
- Referral or authorization records
- Emergency circumstances, if applicable
- Records showing attempts to find in-network care
Documents the Provider Should Normally Create
These Usually Come From Your Provider, Not You
- The corrected claim
- A coding explanation
- The referral
- A retrospective-authorization request
- Clinical records
- A medical-necessity letter
- Peer-to-peer rationale
Representative Documents
Appointment vs. Authorization
Appointing a representative and authorizing them to receive or disclose your health information may be separate functions requiring separate forms. There isn't one UnitedHealthcare form that covers every case, so use the form identified in your denial notice or plan document.
What Not to Send Through the Public Site
Keep Case Documents Off Ordinary Channels
Don't send your denial notice through Facebook, LinkedIn, or social messages. Don't place claim numbers, member IDs, diagnoses, or medical records in ordinary marketing contact forms. Keep your actual case documents for your own appeal, sent only through the route in your denial notice.
Next Step
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