How to appeal a UnitedHealthcare Medicare Advantage skilled nursing (SNF) denial
Why UnitedHealthcare SNF denials happen
UnitedHealthcare is the largest Medicare Advantage insurer in the country, and its post-acute coverage decisions — including those informed by the nH-Predict tool from its naviHealth subsidiary — have drawn significant scrutiny and litigation. SNF denials often arrive while a patient's stay is still in progress, asserting that they have “plateaued,” met their goals, or no longer need a “skilled” level of care. Many land with little individualized review of the actual chart.
First: which notice did you get?
The right move depends entirely on the notice UnitedHealthcare sent. A Notice of Medicare Non-Coverage (NOMNC) — telling you coverage ends on a specific date — is a fast appeal to a Quality Improvement Organization on a very short clock; our free fast-appeal helper walks you through it. A standard denial (Integrated Denial Notice) is a Level 1 reconsideration — the appeal we prepare and certified-mail for $129. Not sure which you have? See how to tell your notice apart, or upload it and we'll identify it for free.
The rules that may be on your side
Federal Medicare rules are clear that skilled coverage does not end simply because a patient has stopped improving — care to maintain function or slow decline can still qualify. A strong appeal ties the specific reason UnitedHealthcare gave back to the federal standards and the clinical facts in your records. That is exactly what Recourse assembles, from a curated library of Medicare regulations, for a Recourse team member to review before anything is mailed.
How Recourse helps
- 1. Upload your denial notice. We read it and identify which appeal applies — free.
- 2. We prepare the appeal. A draft grounded in the Medicare rules for your situation, plus a pre-filled CMS-1696 appointment form.
- 3. You review everything.You read the draft and confirm the plan's name and mailing address before anything is sent. You only pay — a flat $129 — if you choose to mail it.
- 4. We certified-mail it. A Recourse team member reviews it, we mail it to the plan by certified mail, and you get the tracking number and a copy of exactly what was sent.
Frequently asked questions
- How long do I have to appeal a UnitedHealthcare SNF denial?
- It depends on the notice. A standard Integrated Denial Notice generally gives you 60 days to file a Level 1 reconsideration. But if you received a Notice of Medicare Non-Coverage (NOMNC) saying coverage ends on a specific date, that is a fast appeal on a much shorter clock — often a day or two — handled by a Quality Improvement Organization, not by this mail process. Check your notice type first; we will tell you which one you have for free.
- Can I appeal a UnitedHealthcare denial myself for free?
- Yes. You always have the right to file your own Medicare Advantage appeal directly, or to appoint a family member, an attorney, or a free helper such as your State Health Insurance Assistance Program (SHIP). Recourse is a paid convenience for families who do not have the time or the regulatory fluency to do it alone — you are never required to use us.
- What does the $129 include?
- Preparing your appeal letter from a curated library of Medicare regulations, pre-filling your CMS-1696 appointment form, a review by a Recourse team member, and certified mailing to the plan with tracking. You see the draft and confirm the mailing address before you are charged, and you are only charged if you choose to send it.
- Will Recourse guarantee my appeal is approved?
- No. Whether an appeal succeeds depends on the clinical record and the plan's and reviewers' decisions, none of which we control. We prepare, review, and certified-mail a regulatorily-grounded appeal — that is what your fee buys.
- Is Recourse a law firm or connected to UnitedHealthcare or Medicare?
- No. Recourse is independent — not a law firm, and not affiliated with UnitedHealthcare, Medicare, or CMS. The plan whose denial you are appealing is the adverse party, not our partner. Nothing we provide is legal or medical advice.
Recourse is independent and is not affiliated with, endorsed by, or sponsored by Medicare, CMS, any government agency, or any health plan, including the plan whose denial you are appealing. Recourse is not a law firm and does not provide legal advice; we help you prepare and submit an appeal you are entitled to file under federal Medicare Advantage rules. Filing an appeal is your right and you may do it yourself for free. Appeal letters and statements are drafted with the assistance of AI and reviewed by a Recourse team member before any document is mailed. Drafts are provided for your review and are not legal or medical advice.