{"id":"unitedhealthcare","page":"https://escalate.alexgaoth.com/#/c/unitedhealthcare","html":"https://escalate.alexgaoth.com/c/unitedhealthcare/","generated":"2026-10-15","company":{"id":"unitedhealthcare","name":"UnitedHealthcare","aliases":["uhc","united healthcare","united health care","unitedhealth group","myuhc","uhc community plan","aarp medicare plans"],"sector":"insurance_health","parent":"UnitedHealth Group","website":"https://www.uhc.com","account_url":"https://www.uhc.com/sign-in","regulators":["dol-ebsa","cms-no-surprises"],"channels":[{"id":"member-services-phone","type":"phone","label":"Members with a plan through work (employer plans)","value":"+1-866-801-4409","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"TTY 711. The number on the back of the member ID card takes precedence. Individual and family, Medicare and Community Plan members use plan- and state-specific numbers on the contact page.","source":"https://www.uhc.com/contact-us","last_verified":"2026-10-12"},{"id":"appeals-form","type":"web_form","label":"Member appeal, grievance or ERISA document request form (online)","value":"https://memberforms.uhc.com/Memberappealsandgrievances.html","purposes":["claim_denial","billing_error","poor_service"],"access":"open","notes":"Covers Empire Plan, UHC West, Oxford and all other employer and individual plans; not for behavioral health, dental or vision except individual and family plans. One form per claim or authorization. Needs email and phone verification. Uploads up to 25 MB.","source":"https://memberforms.uhc.com/Memberappealsandgrievances.html","last_verified":"2026-10-12"},{"id":"appeals-mail","type":"mail","label":"Written appeals (employer and individual plans that use the standard address)","value":"UnitedHealthcare Member Inquiry/Appeals, P.O. Box 740816, Atlanta, GA 30374-0816","purposes":["claim_denial","billing_error"],"notes":"Some plans (for example the Empire Plan) use other addresses. Check the denial letter or EOB first. You don't need to send EOBs.","source":"https://member.uhc.com/myuhc/content/campaigns/myuhc-2-0/medical-appeals-grievances/address-rights-information/appeals-custom-address/jcr:content/par.html","last_verified":"2026-10-12"},{"id":"appeals-page","type":"web_form","label":"Your appeal and grievance rights (member site)","value":"https://member.uhc.com/myuhc/claims/appeal-grievance-rights","purposes":["claim_denial"],"source":"https://member.uhc.com/myuhc/claims/appeal-grievance-rights","last_verified":"2026-10-12"},{"id":"medicare-appeals-page","type":"web_form","label":"Medicare Advantage appeals and grievances","value":"https://www.uhc.com/medicare/resources/ma-pdp-information-forms/medicare-appeal.html","purposes":["claim_denial","poor_service"],"source":"https://www.uhc.com/medicare/resources/ma-pdp-information-forms/medicare-appeal.html","last_verified":"2026-10-12"},{"id":"medicare-appeals-mail","type":"mail","label":"Medicare Advantage appeals and grievances department (address in 2024 Evidence of Coverage documents)","value":"UnitedHealthcare Appeals and Grievances Department, P.O. Box 6106, MS CA124-0157, Cypress, CA 90630-0016","purposes":["claim_denial"],"notes":"Listed in several 2024 AARP Medicare Advantage and UHC Medicare Advantage Evidence of Coverage documents; confirm in your plan's current EOC. Expedited appeal fax 1-866-373-1081. Part D appeals: P.O. Box 6106, MS CA124-0197, Cypress, CA 90630-0016; fax 1-866-308-6294 (standard) or 1-866-308-6296 (expedited).","source":"https://www.uhc.com/medicare/alphadog/AAMN24LP0126254_000","last_verified":"2026-10-12"},{"id":"contact-page","type":"web_form","label":"Contact UnitedHealthcare (numbers by plan type and state)","value":"https://www.uhc.com/contact-us","purposes":["claim_denial","claim_delay","billing_error","poor_service"],"notes":"Linked from the UnitedHealth Group contact page for people without a member ID card.","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"},{"id":"claim-status","type":"portal","label":"Review claims and EOBs (member login)","value":"https://member.uhc.com/claims-and-accounts/claims","purposes":["claim_delay","claim_denial","billing_error","surprise_medical_bill"],"access":"login","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"},{"id":"uhg-phone","type":"phone","label":"UnitedHealth Group general line (not member services)","value":"+1-800-328-5979","notes":"UnitedHealth Group tells health plan members to call the number on the member ID card.","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"},{"id":"uhg-mail","type":"mail","label":"UnitedHealth Group corporate mailing address (not an appeals address)","value":"UnitedHealth Group, P.O. Box 1459, Minneapolis, MN 55440-1459","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"}],"escalation":[{"rung":"frontline","channel":"member-services-phone","note":"Call the member services number on the back of the member ID card."},{"rung":"written_complaint","channel":"appeals-form","note":"Internal appeal or grievance online, or by mail to the address on the denial letter or EOB."},{"rung":"state_agency","agency_kind":"insurance_department","note":"External review for fully insured plans; complaint to the state."},{"rung":"regulator","regulator":"dol-ebsa","note":"Employer self-funded (ERISA) plans."},{"rung":"regulator","regulator":"cms-no-surprises","note":"Surprise bills under the No Surprises Act."}],"playbooks":[{"issue":"claim_denial","summary":"Appeal within 180 days of the denial (most plans) online or by mail, then ask for external review. Medicare Advantage members have 65 days.","evidence":["denial letter or EOB","member ID card","medical records","provider letter of medical necessity","receipts"],"steps":[{"do":"Log in and download the EOB for the denied claim.","channel":"claim-status"},{"do":"Call the number on the member ID card. Ask for the denial reason, the appeal deadline, the appeal address and a free copy of the documents relevant to the claim.","channel":"member-services-phone"},{"do":"File the appeal with the online form (one form per claim), or mail it to the address on the denial letter or EOB. Attach receipts and records; EOBs are not needed.","channel":"appeals-form"},{"do":"Medicare Advantage members file within 65 days at the Medicare appeals page or the address in the plan's Evidence of Coverage. Ask for an expedited appeal if waiting could seriously harm health.","channel":"medicare-appeals-page"},{"do":"After the final internal denial, ask for external review through the state insurance department (fully insured plans) or the plan's process. For employer self-funded plans, contact the Department of Labor if the plan does not follow the rules.","regulator":"dol-ebsa"}],"facts":[{"kind":"deadline","claim":"UnitedHealthcare says most plans allow 180 days from receipt of the claim denial to submit an appeal; check your plan document for your appeal rights.","issues":["claim_denial"],"source":"https://member.uhc.com/myuhc/content/campaigns/myuhc-2-0/medical-appeals-grievances/address-rights-information/appeals-custom-address/jcr:content/par.html","last_verified":"2026-10-12"},{"kind":"deadline","claim":"For UnitedHealthcare of California plans, a grievance may be submitted within 180 calendar days following the incident; UnitedHealthcare acknowledges it within 5 calendar days, answers within 30 calendar days for a standard review, and decides urgent problems within 3 calendar days.","issues":["claim_denial","poor_service"],"source":"https://memberforms.uhc.com/Memberappealsandgrievances.html","last_verified":"2026-10-12"},{"kind":"deadline","claim":"For UnitedHealthcare Medicare Advantage plans, you may file an appeal within 65 calendar days of the date of the notice of the initial organization determination, and a grievance within 60 calendar days of the circumstance. Expedited Part C pre-service appeals are decided within 72 hours.","issues":["claim_denial"],"source":"https://www.uhc.com/medicare/resources/ma-pdp-information-forms/medicare-appeal.html","last_verified":"2026-10-12"}]},{"issue":"billing_error","summary":"Compare the provider bill with the EOB, then call member services.","evidence":["provider bill","EOB","member ID card"],"steps":[{"do":"Compare the provider bill with the EOB.","channel":"claim-status"},{"do":"Call the number on the member ID card about a claim processed wrongly. Ask the provider to rebill to the EOB amount."},{"do":"If it is not fixed, file an appeal or grievance with the online form.","channel":"appeals-form"}]},{"issue":"surprise_medical_bill","summary":"Compare the bill with the EOB, tell UnitedHealthcare and the provider, then contact the CMS help desk.","evidence":["the bill","EOB","member ID card"],"steps":[{"do":"Compare the bill with the EOB. Note whether it was emergency care or care at an in-network facility.","channel":"claim-status"},{"do":"Tell UnitedHealthcare (number on the ID card) and the provider that the bill may be a surprise bill."},{"do":"Contact the CMS No Surprises Help Desk.","regulator":"cms-no-surprises"}]}],"facts":[{"kind":"contact","claim":"UnitedHealth Group tells health plan members to call the number on their health plan ID card, and people without an ID card to use the Contact UnitedHealthcare page.","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"}],"known_blockers":["uhc.com and member.uhc.com return 403 to automated page readers; most values come from official-domain search results. The online appeal form (memberforms.uhc.com) is readable.","Member phone numbers and appeal addresses are plan-specific; use the ID card and the denial letter. The Medicare appeal address comes from 2024 plan documents.","The online appeal form needs email and phone verification codes, which an agent cannot receive without the member.","Claims and EOBs need a member login."],"notes":"UnitedHealthcare is the health benefits business of UnitedHealth Group. The UnitedHealthcare Medicare Solutions and Community Plan (Medicaid) sites redirect to uhc.com; AARP Medicare plan pages tell members to call the number on the back of the member ID card. Medicare and Medicaid plans have their own appeal rules.","official_domains":["uhc.com","unitedhealthgroup.com"]},"playbooks":{"claim_denial":{"company":{"id":"unitedhealthcare","name":"UnitedHealthcare","sector":"insurance_health","website":"https://www.uhc.com","account_url":"https://www.uhc.com/sign-in"},"issue":{"id":"claim_denial","name":"Insurance claim denied"},"playbook_source":"company","summary":"Appeal within 180 days of the denial (most plans) online or by mail, then ask for external review. Medicare Advantage members have 65 days.","evidence":["denial letter or EOB","member ID card","medical records","provider letter of medical necessity","receipts"],"steps":[{"do":"Log in and download the EOB for the denied claim.","channel":{"id":"claim-status","type":"portal","label":"Review claims and EOBs (member login)","value":"https://member.uhc.com/claims-and-accounts/claims","purposes":["claim_delay","claim_denial","billing_error","surprise_medical_bill"],"access":"login","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"}},{"do":"Call the number on the member ID card. Ask for the denial reason, the appeal deadline, the appeal address and a free copy of the documents relevant to the claim.","channel":{"id":"member-services-phone","type":"phone","label":"Members with a plan through work (employer plans)","value":"+1-866-801-4409","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"TTY 711. The number on the back of the member ID card takes precedence. Individual and family, Medicare and Community Plan members use plan- and state-specific numbers on the contact page.","source":"https://www.uhc.com/contact-us","last_verified":"2026-10-12"}},{"do":"File the appeal with the online form (one form per claim), or mail it to the address on the denial letter or EOB. Attach receipts and records; EOBs are not needed.","channel":{"id":"appeals-form","type":"web_form","label":"Member appeal, grievance or ERISA document request form (online)","value":"https://memberforms.uhc.com/Memberappealsandgrievances.html","purposes":["claim_denial","billing_error","poor_service"],"access":"open","notes":"Covers Empire Plan, UHC West, Oxford and all other employer and individual plans; not for behavioral health, dental or vision except individual and family plans. One form per claim or authorization. Needs email and phone verification. Uploads up to 25 MB.","source":"https://memberforms.uhc.com/Memberappealsandgrievances.html","last_verified":"2026-10-12"}},{"do":"Medicare Advantage members file within 65 days at the Medicare appeals page or the address in the plan's Evidence of Coverage. Ask for an expedited appeal if waiting could seriously harm health.","channel":{"id":"medicare-appeals-page","type":"web_form","label":"Medicare Advantage appeals and grievances","value":"https://www.uhc.com/medicare/resources/ma-pdp-information-forms/medicare-appeal.html","purposes":["claim_denial","poor_service"],"source":"https://www.uhc.com/medicare/resources/ma-pdp-information-forms/medicare-appeal.html","last_verified":"2026-10-12"}},{"do":"After the final internal denial, ask for external review through the state insurance department (fully insured plans) or the plan's process. For employer self-funded plans, contact the Department of Labor if the plan does not follow the rules.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}}],"channels":[{"id":"member-services-phone","type":"phone","label":"Members with a plan through work (employer plans)","value":"+1-866-801-4409","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"TTY 711. The number on the back of the member ID card takes precedence. Individual and family, Medicare and Community Plan members use plan- and state-specific numbers on the contact page.","source":"https://www.uhc.com/contact-us","last_verified":"2026-10-12"},{"id":"appeals-form","type":"web_form","label":"Member appeal, grievance or ERISA document request form (online)","value":"https://memberforms.uhc.com/Memberappealsandgrievances.html","purposes":["claim_denial","billing_error","poor_service"],"access":"open","notes":"Covers Empire Plan, UHC West, Oxford and all other employer and individual plans; not for behavioral health, dental or vision except individual and family plans. One form per claim or authorization. Needs email and phone verification. Uploads up to 25 MB.","source":"https://memberforms.uhc.com/Memberappealsandgrievances.html","last_verified":"2026-10-12"},{"id":"appeals-mail","type":"mail","label":"Written appeals (employer and individual plans that use the standard address)","value":"UnitedHealthcare Member Inquiry/Appeals, P.O. Box 740816, Atlanta, GA 30374-0816","purposes":["claim_denial","billing_error"],"notes":"Some plans (for example the Empire Plan) use other addresses. Check the denial letter or EOB first. You don't need to send EOBs.","source":"https://member.uhc.com/myuhc/content/campaigns/myuhc-2-0/medical-appeals-grievances/address-rights-information/appeals-custom-address/jcr:content/par.html","last_verified":"2026-10-12"},{"id":"appeals-page","type":"web_form","label":"Your appeal and grievance rights (member site)","value":"https://member.uhc.com/myuhc/claims/appeal-grievance-rights","purposes":["claim_denial"],"source":"https://member.uhc.com/myuhc/claims/appeal-grievance-rights","last_verified":"2026-10-12"},{"id":"medicare-appeals-page","type":"web_form","label":"Medicare Advantage appeals and grievances","value":"https://www.uhc.com/medicare/resources/ma-pdp-information-forms/medicare-appeal.html","purposes":["claim_denial","poor_service"],"source":"https://www.uhc.com/medicare/resources/ma-pdp-information-forms/medicare-appeal.html","last_verified":"2026-10-12"},{"id":"medicare-appeals-mail","type":"mail","label":"Medicare Advantage appeals and grievances department (address in 2024 Evidence of Coverage documents)","value":"UnitedHealthcare Appeals and Grievances Department, P.O. Box 6106, MS CA124-0157, Cypress, CA 90630-0016","purposes":["claim_denial"],"notes":"Listed in several 2024 AARP Medicare Advantage and UHC Medicare Advantage Evidence of Coverage documents; confirm in your plan's current EOC. Expedited appeal fax 1-866-373-1081. Part D appeals: P.O. Box 6106, MS CA124-0197, Cypress, CA 90630-0016; fax 1-866-308-6294 (standard) or 1-866-308-6296 (expedited).","source":"https://www.uhc.com/medicare/alphadog/AAMN24LP0126254_000","last_verified":"2026-10-12"},{"id":"contact-page","type":"web_form","label":"Contact UnitedHealthcare (numbers by plan type and state)","value":"https://www.uhc.com/contact-us","purposes":["claim_denial","claim_delay","billing_error","poor_service"],"notes":"Linked from the UnitedHealth Group contact page for people without a member ID card.","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"},{"id":"claim-status","type":"portal","label":"Review claims and EOBs (member login)","value":"https://member.uhc.com/claims-and-accounts/claims","purposes":["claim_delay","claim_denial","billing_error","surprise_medical_bill"],"access":"login","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"},{"id":"uhg-phone","type":"phone","label":"UnitedHealth Group general line (not member services)","value":"+1-800-328-5979","notes":"UnitedHealth Group tells health plan members to call the number on the member ID card.","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"},{"id":"uhg-mail","type":"mail","label":"UnitedHealth Group corporate mailing address (not an appeals address)","value":"UnitedHealth Group, P.O. Box 1459, Minneapolis, MN 55440-1459","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"}],"facts":[{"kind":"deadline","claim":"UnitedHealthcare says most plans allow 180 days from receipt of the claim denial to submit an appeal; check your plan document for your appeal rights.","issues":["claim_denial"],"source":"https://member.uhc.com/myuhc/content/campaigns/myuhc-2-0/medical-appeals-grievances/address-rights-information/appeals-custom-address/jcr:content/par.html","last_verified":"2026-10-12"},{"kind":"deadline","claim":"For UnitedHealthcare of California plans, a grievance may be submitted within 180 calendar days following the incident; UnitedHealthcare acknowledges it within 5 calendar days, answers within 30 calendar days for a standard review, and decides urgent problems within 3 calendar days.","issues":["claim_denial","poor_service"],"source":"https://memberforms.uhc.com/Memberappealsandgrievances.html","last_verified":"2026-10-12"},{"kind":"deadline","claim":"For UnitedHealthcare Medicare Advantage plans, you may file an appeal within 65 calendar days of the date of the notice of the initial organization determination, and a grievance within 60 calendar days of the circumstance. Expedited Part C pre-service appeals are decided within 72 hours.","issues":["claim_denial"],"source":"https://www.uhc.com/medicare/resources/ma-pdp-information-forms/medicare-appeal.html","last_verified":"2026-10-12"},{"kind":"contact","claim":"UnitedHealth Group tells health plan members to call the number on their health plan ID card, and people without an ID card to use the Contact UnitedHealthcare page.","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"aca-appeals-external-review","title":"ACA internal appeals and external review for health coverage","citation":"45 CFR 147.136 (with 29 CFR 2560.503-1 for group health plans)","jurisdiction":"us-federal","status":"in_effect","summary":"After a health plan denies a claim, the patient has 180 days to file an internal appeal. The plan must decide within 30 days (care not yet received), 60 days (care already received) or 72 hours (urgent care). After a final denial, the patient can ask for an independent external review within 4 months; the plan must accept the reviewer's decision.","source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12","points":[{"kind":"deadline","claim":"\"You must file your internal appeal within 180 days (6 months) of receiving notice that your claim was denied.\"","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"deadline","claim":"The internal appeal must be completed within 30 days for a service not yet received and within 60 days for a service already received.","issues":["claim_denial","claim_delay"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"deadline","claim":"For urgent care claims, a group health plan must decide an appeal \"not later than 72 hours after receipt of the claimant's request for review\".","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"process","claim":"In urgent situations, \"You may file an internal appeal and an external review request at the same time.\"","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/","last_verified":"2026-10-12"},{"kind":"policy","claim":"Plans must continue coverage pending the outcome of an appeal, and may not reduce or end benefits for an ongoing course of treatment without advance notice and an opportunity for advance review.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"deadline","claim":"An external review must be requested within \"4 months after the date you receive a notice or final determination\" from the insurer. A standard decision is due no later than 45 days after the request is received; an expedited decision no later than 72 hours.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"},{"kind":"policy","claim":"The insurer is required by law to accept the external reviewer's decision. The HHS-administered process is free; a state or insurer-contracted process may charge, but not more than $25 per review.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"},{"kind":"policy","claim":"If the plan fails to strictly follow the internal claims and appeals requirements, the claimant \"is deemed to have exhausted the internal claims and appeals process\", subject to a de minimis exception.","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"limit","claim":"These internal appeal and external review requirements generally do not apply to grandfathered plans.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/45/147.136","last_verified":"2026-10-12"},{"kind":"contact","claim":"For plans that use the HHS-administered external review process, requests can be filed online with MAXIMUS Federal Services, by calling 1-888-866-6205 for a form, or by email to ferp@maximus.com. For a state process, the contact is in the final denial notice or Explanation of Benefits.","issues":["claim_denial"],"source":"https://www.healthcare.gov/appeal-insurance-company-decision/external-review/","last_verified":"2026-10-12"}]},{"id":"erisa-claims-procedures","title":"ERISA claims procedure timelines for employer benefit plans","citation":"29 CFR 2560.503-1","jurisdiction":"us-federal","status":"in_effect","summary":"Employer-sponsored benefit plans covered by ERISA must decide claims and appeals within set deadlines. Group health plans: 72 hours for urgent care, 15 days for pre-service and 30 days for post-service claims; disability plans: 45 days; other plans: 90 days. Group health and disability claimants get at least 180 days to appeal. If the plan does not follow the procedures, the claimant may sue.","source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12","points":[{"kind":"deadline","claim":"Group health plan initial decisions: urgent care claims \"not later than 72 hours after receipt of the claim by the plan\"; pre-service claims within 15 days, with one extension of up to 15 days; post-service claims \"not later than 30 days after receipt of the claim\", with one extension of up to 15 days.","issues":["claim_delay","claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Disability claims: notice of decision \"not later than 45 days after receipt of the claim by the plan\", with an extension of up to 30 days and a second extension of up to 30 days. Other plans (not group health or disability): not later than 90 days, with one extension of up to 90 days.","issues":["claim_delay","claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Time to appeal a denial: group health plan and disability claimants must have at least 180 days after receiving the adverse benefit determination. Claimants under other plans must have \"at least 60 days following receipt of a notification\" of the adverse determination.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Group health plan appeal decisions (one-level appeal): urgent care within 72 hours, pre-service within 30 days, post-service within 60 days after the plan receives the appeal. With two appeal levels, each level has 15 days (pre-service) or 30 days (post-service).","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Appeal decisions for other plans are due not later than 60 days after the request for review (up to 60 more days in special circumstances); for disability plans the period is 45 days.","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"policy","claim":"On appeal, the plan must provide, \"upon request and free of charge, reasonable access to, and copies of, all documents\" relevant to the claim.","issues":["claim_denial"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"},{"kind":"policy","claim":"If the plan fails to establish or follow these claims procedures, \"a claimant shall be deemed to have exhausted the administrative remedies available under the plan\" and may bring a civil action under ERISA section 502(a).","issues":["claim_denial","claim_delay"],"source":"https://www.law.cornell.edu/cfr/text/29/2560.503-1","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Call the member services number on the back of the member ID card.","channel":{"id":"member-services-phone","type":"phone","label":"Members with a plan through work (employer plans)","value":"+1-866-801-4409","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"TTY 711. The number on the back of the member ID card takes precedence. Individual and family, Medicare and Community Plan members use plan- and state-specific numbers on the contact page.","source":"https://www.uhc.com/contact-us","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal appeal or grievance online, or by mail to the address on the denial letter or EOB.","channel":{"id":"appeals-form","type":"web_form","label":"Member appeal, grievance or ERISA document request form (online)","value":"https://memberforms.uhc.com/Memberappealsandgrievances.html","purposes":["claim_denial","billing_error","poor_service"],"access":"open","notes":"Covers Empire Plan, UHC West, Oxford and all other employer and individual plans; not for behavioral health, dental or vision except individual and family plans. One form per claim or authorization. Needs email and phone verification. Uploads up to 25 MB.","source":"https://memberforms.uhc.com/Memberappealsandgrievances.html","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["uhc.com and member.uhc.com return 403 to automated page readers; most values come from official-domain search results. The online appeal form (memberforms.uhc.com) is readable.","Member phone numbers and appeal addresses are plan-specific; use the ID card and the denial letter. The Medicare appeal address comes from 2024 plan documents.","The online appeal form needs email and phone verification codes, which an agent cannot receive without the member.","Claims and EOBs need a member login."],"security":{"official_domains":["uhc.com","unitedhealthgroup.com"],"never_asks":[],"known_scams":[],"report_phishing":[]},"credibility":{"grade":"A","primary_share":0.935,"sources":{"primary":29,"reference":2},"verified_from":{"page":14},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 94% of 31 sources are the organization's own pages or government sites.","dossier_last_verified":"2026-10-12"},"context":{"dossier":true,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"UnitedHealthcare is the health benefits business of UnitedHealth Group. The UnitedHealthcare Medicare Solutions and Community Plan (Medicaid) sites redirect to uhc.com; AARP Medicare plan pages tell members to call the number on the back of the member ID card. Medicare and Medicaid plans have their own appeal rules.","warnings":[]},"billing_error":{"company":{"id":"unitedhealthcare","name":"UnitedHealthcare","sector":"insurance_health","website":"https://www.uhc.com","account_url":"https://www.uhc.com/sign-in"},"issue":{"id":"billing_error","name":"Billing error"},"playbook_source":"company","summary":"Compare the provider bill with the EOB, then call member services.","evidence":["provider bill","EOB","member ID card"],"steps":[{"do":"Compare the provider bill with the EOB.","channel":{"id":"claim-status","type":"portal","label":"Review claims and EOBs (member login)","value":"https://member.uhc.com/claims-and-accounts/claims","purposes":["claim_delay","claim_denial","billing_error","surprise_medical_bill"],"access":"login","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"}},{"do":"Call the number on the member ID card about a claim processed wrongly. Ask the provider to rebill to the EOB amount."},{"do":"If it is not fixed, file an appeal or grievance with the online form.","channel":{"id":"appeals-form","type":"web_form","label":"Member appeal, grievance or ERISA document request form (online)","value":"https://memberforms.uhc.com/Memberappealsandgrievances.html","purposes":["claim_denial","billing_error","poor_service"],"access":"open","notes":"Covers Empire Plan, UHC West, Oxford and all other employer and individual plans; not for behavioral health, dental or vision except individual and family plans. One form per claim or authorization. Needs email and phone verification. Uploads up to 25 MB.","source":"https://memberforms.uhc.com/Memberappealsandgrievances.html","last_verified":"2026-10-12"}}],"channels":[{"id":"member-services-phone","type":"phone","label":"Members with a plan through work (employer plans)","value":"+1-866-801-4409","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"TTY 711. The number on the back of the member ID card takes precedence. Individual and family, Medicare and Community Plan members use plan- and state-specific numbers on the contact page.","source":"https://www.uhc.com/contact-us","last_verified":"2026-10-12"},{"id":"appeals-form","type":"web_form","label":"Member appeal, grievance or ERISA document request form (online)","value":"https://memberforms.uhc.com/Memberappealsandgrievances.html","purposes":["claim_denial","billing_error","poor_service"],"access":"open","notes":"Covers Empire Plan, UHC West, Oxford and all other employer and individual plans; not for behavioral health, dental or vision except individual and family plans. One form per claim or authorization. Needs email and phone verification. Uploads up to 25 MB.","source":"https://memberforms.uhc.com/Memberappealsandgrievances.html","last_verified":"2026-10-12"},{"id":"appeals-mail","type":"mail","label":"Written appeals (employer and individual plans that use the standard address)","value":"UnitedHealthcare Member Inquiry/Appeals, P.O. Box 740816, Atlanta, GA 30374-0816","purposes":["claim_denial","billing_error"],"notes":"Some plans (for example the Empire Plan) use other addresses. Check the denial letter or EOB first. You don't need to send EOBs.","source":"https://member.uhc.com/myuhc/content/campaigns/myuhc-2-0/medical-appeals-grievances/address-rights-information/appeals-custom-address/jcr:content/par.html","last_verified":"2026-10-12"},{"id":"contact-page","type":"web_form","label":"Contact UnitedHealthcare (numbers by plan type and state)","value":"https://www.uhc.com/contact-us","purposes":["claim_denial","claim_delay","billing_error","poor_service"],"notes":"Linked from the UnitedHealth Group contact page for people without a member ID card.","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"},{"id":"claim-status","type":"portal","label":"Review claims and EOBs (member login)","value":"https://member.uhc.com/claims-and-accounts/claims","purposes":["claim_delay","claim_denial","billing_error","surprise_medical_bill"],"access":"login","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"},{"id":"uhg-phone","type":"phone","label":"UnitedHealth Group general line (not member services)","value":"+1-800-328-5979","notes":"UnitedHealth Group tells health plan members to call the number on the member ID card.","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"},{"id":"uhg-mail","type":"mail","label":"UnitedHealth Group corporate mailing address (not an appeals address)","value":"UnitedHealth Group, P.O. Box 1459, Minneapolis, MN 55440-1459","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"}],"facts":[{"kind":"contact","claim":"UnitedHealth Group tells health plan members to call the number on their health plan ID card, and people without an ID card to use the Contact UnitedHealthcare page.","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"no-surprises-act","title":"No Surprises Act (surprise billing protections and good faith estimates)","citation":"45 CFR part 149 (including 149.420 and 149.610)","jurisdiction":"us-federal","status":"in_effect","summary":"Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.","source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights","last_verified":"2026-10-12","points_omitted":5,"points":[{"kind":"deadline","claim":"Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.law.cornell.edu/cfr/text/45/149.610","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Patient-provider dispute resolution is available when the provider charged \"$400 or more\" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a \"$25 non-refundable administrative fee\".","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}]},{"id":"rosca-negative-option","title":"Restore Online Shoppers' Confidence Act (ROSCA) negative option requirements","citation":"15 U.S.C. 8401-8405","jurisdiction":"us-federal","status":"in_effect","summary":"A seller that charges consumers online through a negative option feature (for example an automatic renewal or a free trial that converts to paid) must clearly disclose all material terms before taking billing information, get the consumer's express informed consent before charging, and provide simple mechanisms to stop recurring charges. The FTC enforces ROSCA.","source":"https://www.law.cornell.edu/uscode/text/15/8403","last_verified":"2026-10-12","points_omitted":4,"points":[{"kind":"policy","claim":"The seller must obtain \"a consumer's express informed consent before charging the consumer's credit card, debit card, bank account, or other financial account\".","issues":["unauthorized_charge","billing_error"],"source":"https://www.law.cornell.edu/uscode/text/15/8403","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Call the member services number on the back of the member ID card.","channel":{"id":"member-services-phone","type":"phone","label":"Members with a plan through work (employer plans)","value":"+1-866-801-4409","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"TTY 711. The number on the back of the member ID card takes precedence. Individual and family, Medicare and Community Plan members use plan- and state-specific numbers on the contact page.","source":"https://www.uhc.com/contact-us","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal appeal or grievance online, or by mail to the address on the denial letter or EOB.","channel":{"id":"appeals-form","type":"web_form","label":"Member appeal, grievance or ERISA document request form (online)","value":"https://memberforms.uhc.com/Memberappealsandgrievances.html","purposes":["claim_denial","billing_error","poor_service"],"access":"open","notes":"Covers Empire Plan, UHC West, Oxford and all other employer and individual plans; not for behavioral health, dental or vision except individual and family plans. One form per claim or authorization. Needs email and phone verification. Uploads up to 25 MB.","source":"https://memberforms.uhc.com/Memberappealsandgrievances.html","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["uhc.com and member.uhc.com return 403 to automated page readers; most values come from official-domain search results. The online appeal form (memberforms.uhc.com) is readable.","Member phone numbers and appeal addresses are plan-specific; use the ID card and the denial letter. The Medicare appeal address comes from 2024 plan documents.","The online appeal form needs email and phone verification codes, which an agent cannot receive without the member.","Claims and EOBs need a member login."],"security":{"official_domains":["uhc.com","unitedhealthgroup.com"],"never_asks":[],"known_scams":[],"report_phishing":[]},"credibility":{"grade":"A","primary_share":0.935,"sources":{"primary":29,"reference":2},"verified_from":{"page":14},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 94% of 31 sources are the organization's own pages or government sites.","dossier_last_verified":"2026-10-12"},"context":{"dossier":true,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"UnitedHealthcare is the health benefits business of UnitedHealth Group. The UnitedHealthcare Medicare Solutions and Community Plan (Medicaid) sites redirect to uhc.com; AARP Medicare plan pages tell members to call the number on the back of the member ID card. Medicare and Medicaid plans have their own appeal rules.","warnings":[]},"surprise_medical_bill":{"company":{"id":"unitedhealthcare","name":"UnitedHealthcare","sector":"insurance_health","website":"https://www.uhc.com","account_url":"https://www.uhc.com/sign-in"},"issue":{"id":"surprise_medical_bill","name":"Surprise medical bill"},"playbook_source":"company","summary":"Compare the bill with the EOB, tell UnitedHealthcare and the provider, then contact the CMS help desk.","evidence":["the bill","EOB","member ID card"],"steps":[{"do":"Compare the bill with the EOB. Note whether it was emergency care or care at an in-network facility.","channel":{"id":"claim-status","type":"portal","label":"Review claims and EOBs (member login)","value":"https://member.uhc.com/claims-and-accounts/claims","purposes":["claim_delay","claim_denial","billing_error","surprise_medical_bill"],"access":"login","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"}},{"do":"Tell UnitedHealthcare (number on the ID card) and the provider that the bill may be a surprise bill."},{"do":"Contact the CMS No Surprises Help Desk.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"channels":[{"id":"member-services-phone","type":"phone","label":"Members with a plan through work (employer plans)","value":"+1-866-801-4409","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"TTY 711. The number on the back of the member ID card takes precedence. Individual and family, Medicare and Community Plan members use plan- and state-specific numbers on the contact page.","source":"https://www.uhc.com/contact-us","last_verified":"2026-10-12"},{"id":"claim-status","type":"portal","label":"Review claims and EOBs (member login)","value":"https://member.uhc.com/claims-and-accounts/claims","purposes":["claim_delay","claim_denial","billing_error","surprise_medical_bill"],"access":"login","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"},{"id":"uhg-phone","type":"phone","label":"UnitedHealth Group general line (not member services)","value":"+1-800-328-5979","notes":"UnitedHealth Group tells health plan members to call the number on the member ID card.","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"},{"id":"uhg-mail","type":"mail","label":"UnitedHealth Group corporate mailing address (not an appeals address)","value":"UnitedHealth Group, P.O. Box 1459, Minneapolis, MN 55440-1459","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"}],"facts":[{"kind":"contact","claim":"UnitedHealth Group tells health plan members to call the number on their health plan ID card, and people without an ID card to use the Contact UnitedHealthcare page.","source":"https://www.unitedhealthgroup.com/contact-us.html","last_verified":"2026-10-12"}],"rules":{"in_force":[{"id":"no-surprises-act","title":"No Surprises Act (surprise billing protections and good faith estimates)","citation":"45 CFR part 149 (including 149.420 and 149.610)","jurisdiction":"us-federal","status":"in_effect","summary":"Protects patients from out-of-network surprise bills for emergency care, for non-emergency care by out-of-network providers at in-network hospitals and surgery centers, and for air ambulance services. People who are uninsured or not using insurance get a good faith estimate and can dispute a bill that is at least $400 over the estimate.","source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights","last_verified":"2026-10-12","points":[{"kind":"limit","claim":"For emergency services, \"you can't be charged any more for emergency medical services than the in-network 'cost-sharing' rate\". This covers the hospital, the providers who treat you there, and air ambulance providers.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/know-your-rights/insurance","last_verified":"2026-10-12"},{"kind":"policy","claim":"The protections cover non-emergency care related to a visit to an in-network hospital, hospital outpatient department or ambulatory surgical center, and air ambulance services. Ground ambulance services generally are not covered by the No Surprises Act billing protections.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/know-your-rights","last_verified":"2026-10-12"},{"kind":"policy","claim":"A patient gives up the protections for non-emergency care only by signing a notice-and-consent form. Providers of ancillary services cannot use that form: emergency medicine, anesthesiology, pathology, radiology and neonatology; assistant surgeons, hospitalists and intensivists; diagnostic services including radiology and laboratory; and any out-of-network provider when no in-network provider is available at the facility.","issues":["surprise_medical_bill"],"source":"https://www.law.cornell.edu/cfr/text/45/149.420","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A notice-and-consent form for services scheduled at least 72 hours in advance must be given not later than 72 hours before the services. For services scheduled within 72 hours, it must be given on the day of scheduling, and no later than 3 hours before the services if given on the same day.","issues":["surprise_medical_bill"],"source":"https://www.law.cornell.edu/cfr/text/45/149.420","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Uninsured or self-pay patients must get a written good faith estimate: not later than 1 business day after scheduling when care is scheduled at least 3 business days ahead; not later than 3 business days after scheduling when scheduled at least 10 business days ahead; and not later than 3 business days after a request.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.law.cornell.edu/cfr/text/45/149.610","last_verified":"2026-10-12"},{"kind":"deadline","claim":"Patient-provider dispute resolution is available when the provider charged \"$400 or more\" than its good faith estimate, for care on or after January 1, 2022, with an initial bill dated within the last 120 calendar days. The patient pays a \"$25 non-refundable administrative fee\".","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"While a patient-provider dispute is in progress, the provider or facility may not move the bill to collections or threaten to, and must stop pursuing payment of a bill already in collections until the dispute is resolved.","issues":["surprise_medical_bill","billing_error"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"contact","claim":"No Surprises Help Desk: 1-800-985-3059, weekdays 8:00 am to 8:00 pm ET and weekends 10:00 am to 6:00 pm ET. Complaints can also be filed online through CMS.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help","last_verified":"2026-10-12"}]}],"not_in_force":[]},"tips":[],"escalation":[{"index":0,"rung":"frontline","note":"Call the member services number on the back of the member ID card.","channel":{"id":"member-services-phone","type":"phone","label":"Members with a plan through work (employer plans)","value":"+1-866-801-4409","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"TTY 711. The number on the back of the member ID card takes precedence. Individual and family, Medicare and Community Plan members use plan- and state-specific numbers on the contact page.","source":"https://www.uhc.com/contact-us","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal appeal or grievance online, or by mail to the address on the denial letter or EOB.","channel":{"id":"appeals-form","type":"web_form","label":"Member appeal, grievance or ERISA document request form (online)","value":"https://memberforms.uhc.com/Memberappealsandgrievances.html","purposes":["claim_denial","billing_error","poor_service"],"access":"open","notes":"Covers Empire Plan, UHC West, Oxford and all other employer and individual plans; not for behavioral health, dental or vision except individual and family plans. One form per claim or authorization. Needs email and phone verification. Uploads up to 25 MB.","source":"https://memberforms.uhc.com/Memberappealsandgrievances.html","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"known_blockers":["uhc.com and member.uhc.com return 403 to automated page readers; most values come from official-domain search results. The online appeal form (memberforms.uhc.com) is readable.","Member phone numbers and appeal addresses are plan-specific; use the ID card and the denial letter. The Medicare appeal address comes from 2024 plan documents.","The online appeal form needs email and phone verification codes, which an agent cannot receive without the member.","Claims and EOBs need a member login."],"security":{"official_domains":["uhc.com","unitedhealthgroup.com"],"never_asks":[],"known_scams":[],"report_phishing":[]},"credibility":{"grade":"A","primary_share":0.935,"sources":{"primary":29,"reference":2},"verified_from":{"page":14},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 94% of 31 sources are the organization's own pages or government sites.","dossier_last_verified":"2026-10-12"},"context":{"dossier":true,"sector_guide":true,"hint":"Call get_context for how this company handles complaints in practice and which scams use its name."},"notes":"UnitedHealthcare is the health benefits business of UnitedHealth Group. The UnitedHealthcare Medicare Solutions and Community Plan (Medicaid) sites redirect to uhc.com; AARP Medicare plan pages tell members to call the number on the back of the member ID card. Medicare and Medicaid plans have their own appeal rules.","warnings":[]}},"escalation":[{"index":0,"rung":"frontline","note":"Call the member services number on the back of the member ID card.","channel":{"id":"member-services-phone","type":"phone","label":"Members with a plan through work (employer plans)","value":"+1-866-801-4409","purposes":["claim_denial","claim_delay","billing_error","surprise_medical_bill","poor_service"],"notes":"TTY 711. The number on the back of the member ID card takes precedence. Individual and family, Medicare and Community Plan members use plan- and state-specific numbers on the contact page.","source":"https://www.uhc.com/contact-us","last_verified":"2026-10-12"}},{"index":1,"rung":"written_complaint","note":"Internal appeal or grievance online, or by mail to the address on the denial letter or EOB.","channel":{"id":"appeals-form","type":"web_form","label":"Member appeal, grievance or ERISA document request form (online)","value":"https://memberforms.uhc.com/Memberappealsandgrievances.html","purposes":["claim_denial","billing_error","poor_service"],"access":"open","notes":"Covers Empire Plan, UHC West, Oxford and all other employer and individual plans; not for behavioral health, dental or vision except individual and family plans. One form per claim or authorization. Needs email and phone verification. Uploads up to 25 MB.","source":"https://memberforms.uhc.com/Memberappealsandgrievances.html","last_verified":"2026-10-12"}},{"index":2,"rung":"state_agency","note":"External review for fully insured plans; complaint to the state.","agency_kind":"insurance_department","agencies":"Ask for the person's state, then call find_regulators."},{"index":3,"rung":"regulator","note":"Employer self-funded (ERISA) plans.","regulator":{"id":"dol-ebsa","name":"U.S. Department of Labor, Employee Benefits Security Administration","level":"federal","when_to_use":"Use for a problem with a private-sector employer health or retirement plan (ERISA plan), such as a denied or delayed claim, after you follow the plan's own claim and appeal steps. Government and church plans are generally not covered.","channels":[{"id":"health-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (health plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","purposes":["claim_denial","claim_delay"],"notes":"Asks for name, ZIP, state, phone, email, the last four digits of the Social Security number, and an attestation that you are the person the information applies to. The account holder must confirm this personally.","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"retirement-plan-form","type":"web_form","label":"Request help from a Benefits Advisor (retirement plan)","value":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=4","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"},{"id":"phone","type":"phone","label":"EBSA Benefits Advisors","value":"+1-866-444-3272","source":"https://beta.dol.gov/about/agencies/ebsa/ask-ebsa","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"ERISA sets minimum standards for most voluntarily established retirement and health plans in private industry. In general it does not cover group health plans of government entities or church plans.","source":"https://www.dol.gov/general/topic/health-plans/erisa","last_verified":"2026-10-12"},{"kind":"process","claim":"For a complaint under Title I of ERISA, expect a status report from the assigned benefits advisor every 30 days.","source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"},{"kind":"process","claim":"EBSA can help you understand your rights, but you should still review the plan documents and meet the plan's claim and appeal deadlines.","issues":["claim_denial"],"source":"https://www.askebsa.dol.gov/WebIntake/home.aspx/info?id=3","last_verified":"2026-10-12"}],"notes":"On 2026-10-12, www.askebsa.dol.gov and the old Ask EBSA page redirected to https://beta.dol.gov/about/agencies/ebsa/ask-ebsa, which links to the WebIntake forms above. EBSA regional offices: https://www.dol.gov/agencies/ebsa/about-ebsa/about-us/regional-offices"}},{"index":4,"rung":"regulator","note":"Surprise bills under the No Surprises Act.","regulator":{"id":"cms-no-surprises","name":"CMS No Surprises Help Desk","level":"federal","when_to_use":"Use for an out-of-network surprise bill for emergency care, for care at an in-network hospital or surgery center, or for air ambulance. Uninsured or self-pay patients use the dispute process when a bill is at least $400 over the good faith estimate.","channels":[{"id":"complaint-form","type":"web_form","label":"Submit a No Surprises complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/get-started","purposes":["surprise_medical_bill"],"notes":"The form resets after 15 minutes of inactivity and the answers are deleted. Save the confirmation number.","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"complaint-update","type":"web_form","label":"Add documents to an existing complaint","value":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint/update","source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"id":"help-desk","type":"phone","label":"No Surprises Help Desk","value":"+1-800-985-3059","hours":"Phone support 7 days a week (hours not stated)","notes":"Help in English, Spanish and more than 350 other languages. Call with the confirmation number to check status.","source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"},{"id":"bill-dispute","type":"web_form","label":"Patient-provider bill dispute (uninsured or self-pay)","value":"https://nsa-idr.cms.gov/billdisputes/s/","purposes":["surprise_medical_bill"],"notes":"A $25 non-refundable fee applies. A mail or fax initiation form is at https://www.cms.gov/files/document/billing-dispute-initiation-form.pdf","source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"}],"facts":[{"kind":"process","claim":"The Help Desk reviews the complaint and documents, and may investigate compliance with federal law or refer the complaint to another federal or state authority. If it needs more information it contacts you within 60 days.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"process","claim":"Attach the medical bill, a photo of the insurance card, and any explanation of benefits. If you have them, add the good faith estimate, a signed notice and consent form, provider letters, appeal decisions and evidence of coverage.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/submit-a-complaint","last_verified":"2026-10-12"},{"kind":"deadline","claim":"A patient-provider dispute needs an initial bill dated within the last 120 calendar days, from a provider or facility that charged at least $400 more than its good faith estimate, for care on or after January 1, 2022 that you did not use insurance to pay for.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"fee","claim":"The patient-provider dispute has a $25 non-refundable administrative fee and does not start until it is paid. If you win, the $25 is deducted from what you owe the provider.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights/help/dispute-a-bill","last_verified":"2026-10-12"},{"kind":"policy","claim":"The No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.","issues":["surprise_medical_bill"],"source":"https://www.cms.gov/medical-bill-rights","last_verified":"2026-10-12"}],"notes":"The independent dispute resolution (IDR) process on cms.gov/nosurprises is a separate payment dispute process between providers and plans; it is not the patient complaint path. CMS lists no TTY or mailing address for the Help Desk."}}],"security":{"official_domains":["uhc.com","unitedhealthgroup.com"],"never_asks":[],"known_scams":[],"report_phishing":[]},"credibility":{"grade":"A","primary_share":0.935,"sources":{"primary":29,"reference":2},"verified_from":{"page":14},"last_verified":"2026-10-12","oldest_verified":"2026-10-12","stale_items":0,"explanation":"Grade A (high: almost everything comes from official pages read directly). 94% of 31 sources are the organization's own pages or government sites.","dossier_last_verified":"2026-10-12"},"dossier":{"title":"UnitedHealthcare — how complaints actually go","last_verified":"2026-10-12","file":"dossiers/unitedhealthcare.md","markdown":"## In short\n\nCall the number on your member ID card and get the denial in writing, then appeal: most commercial plans follow the federal 180-day internal appeal and 4-month external review rules, and Medicare Advantage plans have their own Medicare steps. Appeal even when it feels pointless: federal investigators found that UnitedHealthcare overturned 99.7 percent of appealed Medicare Advantage denials for skilled nursing facility admission in June 2024. In California, grievances go through UnitedHealthcare's online form, then to the Department of Managed Health Care and Independent Medical Review.\n\n## How complaints actually go\n\n- Members should sign in to their plan account or call the number on their health plan ID card; people without a card use the Contact UnitedHealthcare page. UnitedHealth Group's main number is (800) 328-5979. [UnitedHealth Group contact](https://www.unitedhealthgroup.com/contact-us.html)\n- Appeals, grievances and requests for ERISA plan documents can be filed online (Empire, UHC West, Oxford and other employer and individual plans; not behavioral health, dental or vision except individual family plans). [UnitedHealthcare appeals and grievances form](https://memberforms.uhc.com/Memberappealsandgrievances.html)\n- California: submit a grievance within 180 calendar days of the incident; UnitedHealthcare acknowledges within 5 calendar days and answers a standard grievance within 30 calendar days, or 3 calendar days if urgent. Members may also qualify for Independent Medical Review through the DMHC. [UnitedHealthcare appeals and grievances form](https://memberforms.uhc.com/Memberappealsandgrievances.html)\n- For other commercial plans, the federal rules give 180 days to file an internal appeal and 4 months after the final denial to ask for external review, which the insurer must follow. [HealthCare.gov: internal appeals](https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/) [HealthCare.gov: external review](https://www.healthcare.gov/appeal-insurance-company-decision/external-review/)\n\n## What tends to work\n\n- Appeal Medicare Advantage post-acute care denials. In June 2024, UnitedHealth Group denied 12.9 percent of skilled nursing facility admission requests and overturned 99.7 percent of the denials that were appealed; it received 42 percent of all such appeals among the 19 insurers studied. [HHS OIG OEI-09-24-00331, June 2026](https://oig.hhs.gov/documents/audit/11694/OEI-09-24-00331.pdf)\n- Its contractor naviHealth, a UnitedHealth Group subsidiary, processed half of all skilled nursing requests in the study and denied 14 percent; 97 percent of naviHealth denials that were appealed were overturned. [HHS OIG OEI-09-24-00331, June 2026](https://oig.hhs.gov/documents/audit/11694/OEI-09-24-00331.pdf)\n- In Medicaid managed care, UnitedHealth overturned 81 percent of appealed prior authorization denials in 2025 data. [KFF, August 2026](https://www.kff.org/patient-consumer-protections/prior-authorization-metrics-provide-new-insights-into-insurer-practices-but-gaps-remain/)\n- In urgent cases, file the internal appeal and the external review request at the same time. [HealthCare.gov: internal appeals](https://www.healthcare.gov/appeal-insurance-company-decision/internal-appeals/)\n\n## Traps and fine print\n\n- Member phone numbers and appeal addresses are plan-specific; use the ID card and the denial letter rather than a number from a search result. [UnitedHealth Group contact](https://www.unitedhealthgroup.com/contact-us.html)\n- The online appeal form does not cover behavioral health, dental or vision services, except for individual family plans. [UnitedHealthcare appeals and grievances form](https://memberforms.uhc.com/Memberappealsandgrievances.html)\n- Federal employees in California have grievance rights through the Office of Personnel Management instead of the DMHC. [UnitedHealthcare appeals and grievances form](https://memberforms.uhc.com/Memberappealsandgrievances.html)\n\n## By the numbers\n\n- 2025 prior authorization data: UnitedHealth denied 17 percent of standard requests in Medicare Advantage, 11 percent in Medicaid managed care and 21 percent in the ACA Marketplace. [KFF, August 2026](https://www.kff.org/patient-consumer-protections/prior-authorization-metrics-provide-new-insights-into-insurer-practices-but-gaps-remain/)\n- In a July 14, 2026 letter, Senators Blumenthal and Hawley of the Senate Permanent Subcommittee on Investigations cited an HHS OIG report finding that UnitedHealthcare denied 66 percent of inpatient rehabilitation facility admission requests, against an average of 41 percent at 16 smaller Medicare Advantage insurers. [Senate PSI letter to UnitedHealthcare](https://www.hsgac.senate.gov/wp-content/uploads/2026-07-14-letter-to-UHC.pdf)\n\n## Scams that target customers\n\n- Medicare will never call you to sell anything or visit your home; give your Medicare number only to your doctor, your insurer or others who should have it. Report Medicare Advantage plan fraud to the I-MEDIC at 1-877-772-3379. [Medicare.gov: reporting fraud and abuse](https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse)\n- \"Free\" genetic tests and cheek swabs offered by phone, at events or door to door are used to steal Medicare information; refuse kits your doctor did not order. [HHS OIG genetic testing alert](https://oig.hhs.gov/fraud/consumer-alerts/fraud-alert-genetic-testing-scam/)\n- To check a caller who says they are from UnitedHealthcare, hang up and call the number on your health plan ID card. [UnitedHealth Group contact](https://www.unitedhealthgroup.com/contact-us.html)\n"},"guide":{"key":"insurance_health","title":"Health insurance — how complaints work","last_verified":"2026-10-12","file":"guides/insurance_health.md","page":"https://escalate.alexgaoth.com/#/guides/insurance_health"}}