How do I appeal a health insurance denial?

You can appeal a health insurance denial by writing a formal appeal letter citing the specific reason for denial, relevant medical evidence, and applicable federal and state laws. Healthcare Watchdog's free AI tool generates a professional appeal letter in minutes, citing the exact laws and regulations your insurer may have violated.

Is this insurance appeal tool really free?

Yes, Healthcare Watchdog's AI appeal letter generator is completely free. There are no hidden fees, no paywalls, and no data sold. The platform was built by a patient who experienced insurance denial firsthand.

What types of insurance denials can I appeal?

You can appeal medical necessity denials, out-of-network denials, prior authorization denials, experimental treatment denials, and more. Our tool works for all major insurers including UnitedHealthcare, Aetna, Cigna, Blue Cross Blue Shield, and Humana.

How long do I have to appeal an insurance denial?

Appeal deadlines vary by state and insurer, typically ranging from 30 to 180 days. Under the ACA, you generally have 180 days for internal appeals and 4 months for external review. Check your specific state's deadlines on our State Rights page.

What is the success rate of insurance appeals?

Studies show that roughly 50% of insurance appeals are successful, yet fewer than 1% of denied claims are ever appealed. This means millions of people are paying for care that should have been covered. A well-written appeal letter with proper legal citations significantly increases your chances.

Back to Case Database

Ongoingdoj enforcement

United States v. UnitedHealth Group - Medicare Advantage Fraud Investigation

U.S. Department of Justice -- Filed February 12, 2024

View Source

Case Summary

The Department of Justice filed suit against UnitedHealth Group alleging the company systematically submitted inflated and unsupported Medicare Advantage diagnosis codes to fraudulently obtain higher payments from the federal government. The government alleges UHG used chart review programs specifically designed to add diagnoses that were not supported by patient medical records, defrauding Medicare out of billions of dollars.

Key Findings

The DOJ alleges that UnitedHealth Group used chart review programs to add unsupported diagnoses to Medicare Advantage claims, resulting in fraudulent overpayments.

AI Analysis

The Department of Justice alleges that UnitedHealth Group systematically submitted inflated and unsupported diagnosis codes to Medicare Advantage plans to obtain higher payments. The company allegedly used chart review programs designed to add diagnoses not supported by patients' medical records. This conduct is said to have defrauded Medicare out of billions of dollars. The lawsuit seeks to recover the fraudulent payments and hold the company accountable. If proven, it could lead to significant financial penalties and changes to UHG's billing practices.

Original Source

Case Details

Case Number

DOJ-2024-UHG-MEDICARE

Defendant

UnitedHealth Group

Jurisdiction

Federal

Violation Type

false claims

Outcome

Pending

Filed

February 12, 2024

Keywords

unitedhealth groupmedicare advantagediagnosis codingchart reviewfraudfalse claimsdojbilling

Source: doj_manual

Last updated: February 19, 2026