A message to brokers, consultants and employers
In the wake of the Dec. 4, 2024, tragedy, several questions, concerns and misconceptions have surfaced. Here are answers to some of the most common inquiries.
Your trust means a lot to us, and we work to earn it every day. That’s why we feel it’s important to address the information you may be reading in the news about UnitedHealthcare, as well as answer any questions that may arise.
For 50 years, we’ve been committed to helping our members live healthier lives and helping make the health system work better for everyone. We are the health benefits carrier of choice for more than 235,000 employers,1 and we don’t take that responsibility lightly. We believe in being open with those we serve and acting with integrity.
In that spirit, here are answers to some of the questions we’ve been receiving:
How often does UnitedHealthcare deny claims, and why do they get denied?
UnitedHealthcare ultimately pays 98% of all claims received for eligible members as long as the claims are submitted in a timely manner, do not contain missing or incorrect information and are not duplicate submissions.2 Claims that don’t meet these criteria may initially be denied, but — after further review — many are eventually approved and paid.
For the remaining 2% of claims that are not approved, the majority are instances in which the services are not included in the member’s plan as determined by their employer or plan sponsor.2 And of that 2%, only 0.5% are denied based on clinical guidelines and patient safety standards.2
At UnitedHealthcare, we are focused on protecting patient safety, supporting evidence-based care and ensuring services are delivered in optimal care settings. These criteria help determine whether a claim is approved or denied and is continuously evaluated and refined. That’s also why prior authorizations are important, because they can help identify any potential issues prior to a claim being submitted.
How often does UnitedHealthcare require prior authorization before a service or procedure is performed?
While prior authorizations are an important checkpoint to ensure a service or procedure is safe and a medically appropriate option — and to help ensure employees don’t pay out-of-pocket for care they don’t need — UnitedHealthcare has streamlined or even eliminated this step for common services and procedures, when and where appropriate.
In fact, more than 99% of the time, UnitedHealthcare does not require prior approval, or the approval is obtained quickly (within an average of 2 days or fewer).2 This helps prevent care from being delayed, leading to a better member experience.
UnitedHealthcare also launched its Gold Card Program in October 2024, which recognizes provider groups who consistently adhere to evidence-based care guidelines. Gold Card provider groups will see a reduction in their total prior authorization request volume.
Why is the cost of health care so high, and what is UnitedHealthcare doing about it?
There’s no denying that health care costs in the U.S. are too high. In fact, they’re almost 2 times higher than other countries.3 There are many factors that contribute to those costs, including prices set by providers, hospitals and other care facilities, pharmaceutical companies and others. The role of UnitedHealthcare and its affiliate company, Optum, is to help negotiate those prices down, which saves our clients and their employees billions every year.
We also work hand in hand with our clients to design a benefits package that incorporates a mix of health plans and products that fit their unique needs and budgets and meet regulatory standards. And with proven cost management strategies, our goal is to help employers ensure they’re offering their workforces robust benefits at an affordable cost.
As the nation’s largest health care company, we recognize the role we play in addressing health care costs and will continue to use our resources to do so, but it’s a group effort. No one entity can do it alone. Making lasting and meaningful change requires collaboration across the industry, and that’s why we are actively working alongside providers, pharmaceutical companies, hospitals, government policymakers and clients to transform the U.S. health system so that it works better for everyone.
What is UnitedHealthcare doing to deliver a simpler health care experience?
The U.S. health care system is complex. Because it was not designed by any one person or entity, it has many overlapping, and in some cases, disjointed elements, with incentives and objectives that are not always aligned.
UnitedHealthcare sees that and is working to create a simpler, more personalized and connected member experience. For instance, we made more than 400 enhancements to our digital experience via the UnitedHealthcare® app and myuhc.com® in 2024 — from accessing health benefits information and personalized recommendations, connecting with quality care, tracking and paying claims and more. This is in addition to the personalized guidance and support delivered by our team of compassionate advocates.
When designing plans and products that support the health of members, our goal is to enable them to get the care they need in a way that feels simple and personal to them.
A message to UnitedHealthcare members
We understand we have a responsibility to deliver this same level of transparency and clarity to our members, and we are committed to doing that. At the end of the day, we are honored to serve the 29.7M+ people4 who have chosen UnitedHealthcare as their employer-sponsored plan of choice, and we don’t take that lightly.
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