How do insurance denial appeals work?

Upload your denial letter and Lysco analyzes it, identifies the denial reason, cites applicable laws (ACA, ERISA, state regulations), and generates a customized appeal letter. You review and submit it yourself.

What is the success rate for insurance appeals?

It varies by plan type. For ACA marketplace plans, about 44% of appealed denials are overturned (KFF, 2023). For Medicare Advantage, it can be as high as 83% (HHS OIG). Many denials stem from billing or administrative errors that get fixed when challenged. Individual results vary.

Is Lysco a law firm or medical practice?

No. Lysco is an informational tool that helps you understand your rights and options. It is not a law firm, medical practice, or insurance company. For specific legal or medical situations, consult a licensed professional.

How much does Lysco cost?

Analysis is always free and your first appeal letter is free too. Upgrade to Pro ($29/mo) or Annual ($199/year) for unlimited appeal letters, insurer playbooks, and benefits finder. Cancel anytime.

Is my health data secure on Lysco?

Yes. Lysco uses AES-256 encryption at rest, TLS for data in transit, and row-level security so only you can access your data. We never sell your data and follow HIPAA-aligned security practices.

UnitedHealthcare

Also known as: UHC, United, UnitedHealth, UnitedHealthcare, Optum

EmployerIndividualMedicare AdvantageMedicaid

Common Denial Patterns

Medical necessity denials citing InterQual criteria
Prior authorization denials for imaging and specialty referrals
Step therapy requirements for specialty medications
Out-of-network denials for services with in-network alternatives

Appeal Best Practices

1Reference the specific UHC clinical policy number in your appeal
2Request the complete claim file and clinical criteria used
3Ask for peer-to-peer review between your doctor and UHC reviewer
4Submit appeal via certified mail with return receipt
5Include a cover letter summarizing all attached evidence

Known Weaknesses

Clinical policies are public — compare denial language to published criteria
Medical necessity reviewers may not be same specialty as treating provider — flag this
InterQual criteria can be narrower than clinical guidelines — cite broader evidence

Contact & Response

Best Contact Method

Member portal > Fax > Certified mail

Typical Response Time

30 days (internal), 45 days (external)

Internal Criteria Used

InterQual
UHC Clinical Policies

State-Specific Notes

CA Department of Insurance has additional consumer protections

NY DFS has independent external review process

TX DOI has expedited complaint process

General Tips

UHC publishes clinical policies online — reference the specific policy in your appeal
Peer-to-peer reviews are often available — request one through the provider
UHC uses InterQual criteria for medical necessity — ask for the specific criteria applied
Appeals can be submitted via the member portal, fax, or mail
For Medicare Advantage denials, use the CMS-approved appeal form

Have a denial from UnitedHealthcare?

Upload your denial letter for free analysis. Lysco uses UnitedHealthcare-specific intelligence to identify weak points and draft your appeal.

Upload Your Denial — Free

This information is for educational purposes based on publicly available data including CMS reports, state insurance department filings, and published insurer guidelines. It does not constitute legal, medical, or financial advice. Individual results vary. Verify all information independently and consult qualified professionals before acting.