Things You Should Know: Addressing Authorization and Denial Issues with Optum and UnitedHealth Group
Breaking the Cycle: Addressing Authorization and Denial Issues with Optum and UnitedHealth Group
At Lincoln Reimbursement Solutions, we are dedicated to advocating for the healthcare providers we serve, ensuring they receive proper reimbursement for services rendered. However, we continue to face persistent and systemic issues with Optum and UnitedHealth Group (UHC) that are causing significant operational inefficiencies and financial strain on our clients.
The Ongoing Problem: Incorrect Authorization Guidance and Claim Denials
Our team has encountered an alarming pattern of receiving incorrect "no authorization required" messages for multiple clients. However, upon claim submission, we are met with denials stating that an authorization was, in fact, required. These denials are issued too late for retroactive authorization requests due to Optum’s strict 10-day appeal window, leaving providers in a frustrating and costly loop.
The situation is widespread, affecting all 200+ clients we service—not just a few. Beyond these incorrect denials, authorization approvals that should take 10-14 days are often exceeding that timeframe, violating Medicare compliance guidelines. Unfortunately, Optum and UHC have provided no guidance or solutions, leaving our team to navigate these issues with excessive rework and long hours on hold, often waiting 1-2 hours per call.
Escalating the Issue—Yet Receiving No Response
Despite numerous escalations to Optum’s leadership, responses have dwindled. The system inconsistencies, conflicting information, and shifting policies create an unpredictable reimbursement landscape, forcing practice owners to either appeal tirelessly or consider writing off balances—an unacceptable outcome for any healthcare business.
To further complicate matters, Optum has recently started designating long-time in-network (INN) providers as out-of-network (OON) due to what appears to be a system glitch. Even Optum's executives have acknowledged the error, attributing it to a cyber attack, but no resolution has been offered. Providers attempting to enroll in the Optum Care/Curo portal are being met with errors stating, "No organization found," despite having valid contracts in place.
A Small Victory: Reprocessing of Denied Claims
Amidst the ongoing turmoil, we have managed to push for some progress. After escalating a particularly egregious case regarding denied claims with valid authorizations, Optum has agreed to reprocess all affected claims. If you have claims that were incorrectly denied for "no authorization," do not resubmit them—Optum has committed to addressing these issues internally. We have already seen some of these claims paid out.
Additionally, for LIFE1 claims, authorization will not be required for services rendered through November 15, though the requirement will resume on November 16. However, due to ongoing portal access issues, we are currently forced to complete authorizations manually and submit them via fax—an archaic and inefficient process in 2024.
Join the Conversation
We urge our fellow practice owners and billing professionals to share their experiences. The more visibility we bring to this issue, the harder it becomes for Optum and UHC to ignore. If you have encountered similar challenges, please reach out—we are stronger together.
At Lincoln Reimbursement Solutions, we remain committed to pushing for fairness and efficiency in healthcare reimbursement. Stay tuned for further updates as we continue this fight.
Let’s hold these payers accountable—our industry depends on it.