Design Highlights
- UnitedHealth and other major insurers have been flagged for alarmingly high denial rates on prior authorization requests, particularly for post-hospital care.
- UnitedHealth’s denial rates for long-term care hospital requests reached 71%, significantly higher than the average 42% among competitors.
- Inpatient rehabilitation requests from UnitedHealth faced a 66% denial rate, compared to a 41% average across other insurers.
- The Senate Homeland Security Committee highlighted that UnitedHealth’s denial rates for post-acute care are three times higher than their overall denial rate.
- Media coverage emphasizes the urgent need for policy reviews to address the rising denial rates and their impact on patient care access.
UnitedHealth’s Medicare Advantage denial rates are raising eyebrows—and not in a good way. Recent findings from the HHS Office of Inspector General reveal that UnitedHealth, along with Humana and CVS, has been denying post-hospital care requests at rates that would make anyone’s head spin. For long-term care hospital requests, UnitedHealth’s denial rate stood at a staggering 71%. In comparison, the average for 16 other Medicare Advantage insurers was a mere 42%. Talk about a discrepancy.
When it comes to inpatient rehabilitation requests, UnitedHealth takes the cake for the highest denial rate at 66%. The average among other insurers? Just 41%. What’s going on here? NBC News reported that some of the largest Medicare Advantage plans are rejecting prior authorization requests for essential services at shockingly high rates. The inspector general’s report pointed out that denial rates can fluctuate dramatically, ranging from 8% to a jaw-dropping 80% across various companies for long-term care.
The Senate Homeland Security Committee chimed in, noting that between 2019 and 2022, UnitedHealthcare’s denial rates for post-acute care prior authorization requests were alarmingly high—three times higher than its overall denial rate in 2022. Is this a strategic move to avoid costly, but necessary, post-acute stays? It sure feels like it. As more requests for long-term acute care hospitals are denied, the pattern becomes hard to ignore. Experts recommend that patients conduct annual policy reviews to better understand their coverage and avoid unexpected denials.
In a broader context, the 2024 Medicare Advantage landscape shows that insurers collectively denied 4.1 million prior authorization requests, up from previous years. That’s 7.7% of all requests—an uptick from 6.4% in 2023. And get this: only 11.5% of those denied requests were appealed. Even worse, when people did appeal, 80.7% of those appeals were overturned. So, it seems like the odds are stacked against patients.
UnitedHealth isn’t just a little above average, either. A 2025 analysis revealed they denied 16.3% of standard prior authorization requests—above the national average of 11.6%. The denial rate for their Medicare Advantage plans averaged 17.5%. Additionally, UHC’s post-acute services PA denial rate averaged 22.7% in 2022, reflecting a concerning trend. Prior authorization denials for urgent requests accounted for nearly 10% of total denials.
In a sea of denial, it’s hard to see the light. UnitedHealth and its peers are clearly raising more questions than answers. The stakes are high, and so are the denial rates.
