At UnitedHealthcare, trust is at the core of everything we do. We understand that choosing a health plan is a significant decision, and we are committed to delivering reliable, high-quality service to our members. Given recent discussions surrounding our claims and prior authorization processes, we want to provide clear and accurate information to help you and your clients make informed decisions.
Understanding Our Claims and Prior Authorization Processes
Claims Payment: Accuracy and Transparency
There has been misinformation circulating regarding how UnitedHealthcare processes claims. To set the record straight:
- We pay 98% of all claims submitted for eligible members, provided they are submitted correctly and in a timely manner.
- Of the 2% of claims not approved, most involve services that do not meet the benefit criteria established by plan sponsors, such as employers, states, or the Centers for Medicare & Medicaid Services (CMS).
- Only 0.5% of claims are denied based on clinical evidence and patient safety concerns.
Prior Authorization: Ensuring Safe, Appropriate Care
Prior authorization is an important step in protecting patient safety and ensuring that care is both necessary and covered under a member’s plan.
- Over 99% of the time, no prior authorization is required, or approvals are obtained within an average of two days or less to avoid any delay in care.
- This process helps prevent unnecessary out-of-pocket expenses and ensures treatments align with the highest standards of medical care.
For additional details, please visit our online resource for more information on our claims and prior authorization policies.
The Value of Choosing UnitedHealthcare
We recognize that you and your clients have many choices when selecting a health care provider. That’s why we remain dedicated to delivering exceptional value through four key pillars:
1. Cost Management
We take a comprehensive approach to managing health care costs, helping members save money while still receiving quality care. Our strategies include:
- Access to UnitedHealthcare Choice and Choice Plus networks, offering competitive discounts.
- Optum Perks Rx discount card to lower prescription costs.
- $0 virtual care through HealthiestYou by Teladoc for affordable and convenient access to care.
2. Enhanced Member Experience
Navigating the health care system can be complex. That’s why we focus on providing a simplified, connected experience through:
- The UHC Member Hub, where members can access plan documents, ID cards, payment details, and more—24/7.
- Personalized support to help members get the most from their coverage, leading to greater satisfaction and plan retention.
3. Innovation in Health Care
Health care isn’t one-size-fits-all, which is why we are continually developing innovative products and solutions to meet diverse needs and budgets.
- Our goal is to design plans that fit a variety of lifestyles and financial situations while ensuring access to high-quality care.
4. Whole-Person Health
Health extends beyond medical care, which is why we take a holistic approach by offering a broad portfolio of health and wellness services, including:
- Virtual health care for convenient access to providers.
- Discounts on dental, vision, hearing, and wellness services.
- Coming in March: Dental Savings Complete – a new discount program for dental, vision, and hearing services.
Thank You for Your Trust
We are honored to serve you, your clients, and every member who places their trust in UnitedHealthcare. Our team is committed to continually improving and delivering on our promise to provide affordable, accessible, and high-quality health care solutions.
Thank you for being a valued partner—we look forward to continuing to support you and your clients for years to come.