UnitedHealthcare Community Plan, Inc. claim denials in Michigan: the federal figures
UnitedHealthcare Community Plan, Inc. denied 33.1% of in-network claims in Michigan — 25,778 claims out of 77,954. Here is what happened to the people who appealed.
What happened to appeals
| Stage | Filed | Overturned |
|---|---|---|
| Internal appeal (to UnitedHealthcare Community Plan, Inc.) | 66 | 37.9% |
| External review (independent) | — | — |
What UnitedHealthcare Community Plan, Inc. denies most
The most common denial reason recorded for UnitedHealthcare Community Plan, Inc. plans in Michigan is other reasons. How that denial is beaten →
| Denial reason | Claims | Share |
|---|---|---|
| Other reasons | 10,414 | 61.4% |
| Administrative reason | 2,467 | 14.6% |
| Service excluded from the plan | 1,597 | 9.4% |
| Member not covered | 946 | 5.6% |
| Provider out of network | 891 | 5.3% |
| Referral required | 639 | 3.8% |
What to do if UnitedHealthcare Community Plan, Inc. denied your claim
- Get the reason in writing. The denial notice must state the specific reason and the plan provision behind it. If it does not, request it — you are entitled to it free of charge.
- File the internal appeal. Generally within 180 days of the denial notice. UnitedHealthcare Community Plan, Inc. overturned 37.9% of the internal appeals it received.
- If they say no again, go external. An independent organization reviews it — not UnitedHealthcare Community Plan, Inc.. Generally you have 4 months from the final internal denial. This is the step nearly everyone skips.
- Ask for expedited review if waiting would seriously jeopardise your health. That timeline is days, not months.
Everything you need for your UnitedHealthcare Community Plan, Inc. appeal: your two deadlines, the argument that fits your denial reason, an evidence checklist, and the external review request. Opens on screen the moment you pay.
Questions
Is UnitedHealthcare Community Plan, Inc.'s denial rate high?
33.1% against a national average of 16% across the plans in this dataset. It is above average. A denial rate describes the insurer, not the merits of your claim.
Does appealing cost anything?
The internal appeal is free. External review is free under the HHS-administered federal process; where an issuer uses a contracted independent review organization or a state process, any fee is capped at $25.
Can UnitedHealthcare Community Plan, Inc. ignore the external decision?
No. External review decisions are binding on the plan.