A message to our members

The team at UnitedHealthcare works to help our members each day by providing simple experiences, affordable coverage and high-quality care. We design plans that support your health and help you easily get care within a complicated health care system. We support you by:

• Managing costs to help save you money
• Making it simpler to find and access care
• Helping you get quality care that’s in step with the most up-to-date medical standards
• Offering preventive and care programs, like annual health visit reminders, maternity health, chronic condition management, cancer screenings, wellness, mental health support and more

On every step of your health care journey, we work to be advocates, guides and partners. We are here to help, so you can focus on what matters to you. 

Read more about how we support our employer clients, state and federal clients, members and providers on our UnitedHealthcare newsroom.

We ultimately pay 98% of all claims received that are for eligible members. For the 2% of claims that are not approved, the majority are instances where the services did not meet the benefit criteria established by the plan sponsor, such as the employer, state or Centers for Medicare & Medicaid Services (CMS). Only 0.5% of claims are not approved based on clinical evidence and patient safety. 

Our care teams are focused on supporting patient safety, evidence-based care, and treatment in the optimal care setting. We continuously evaluate and refine our processes to make it easier for patients and their families.

You can find information on the claim appeals process online:

• UHC Medicare Advantage plans
• UHC Medicaid and Community plans
• Employer-sponsored health plans

For our Medicare Supplement members, Original Medicare determines if medical services and supplies are approved. If approved, claims are then processed based on the specific benefits provided under your AARP Medicare Supplement plan.

Throughout your health care journey, UnitedHealthcare is committed to working with you and providers every step of the way. 

When our members seek care, over 99% of the time there is no prior approval needed, or the approval is obtained quickly (with an average of 2 days or less) so care is not delayed. Prior authorization is an important checkpoint to ensure a service or procedure is a safe and medically appropriate option. Prior authorization also helps ensure members don’t pay out-of-pocket for care they don’t need.

No, your current plan coverage will not change because of recent events. As with every year, any increases in premiums or costs are communicated ahead of time. This communication usually happens during the annual or open enrollment period.

For example, Medicare Advantage and Part D plan benefits are approved annually by the Centers for Medicare & Medicaid (CMS) and are set for 2025. CMS is the federal agency that regulates all insurance carriers.

Artificial intelligence (AI) and machine learning (ML) can help make health care work smarter for our customers, members, providers and consumers.

Our teams are focused on developing and using tools that empower people. These tools can give better insights, more timely information and better experiences. At the same time, they keep safety, privacy and transparency a priority.

We work to ensure that AI and ML models are used safely and responsibly to enable and support decision-making. These tools do not replace critical human decision-making.