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Wiki United Healthcare denial for 59400

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debellis59

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Hermiston, OR
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Hi All.

We have appealed a denial from UHC for a 59400 (vag delivery) and have again been denied. Their reasoning:

Claim denied due to no auth. I called UHC at 1-877-797-8819 and spoke with "person" (Call reference #xxxxx) she advised that the claim denied to no auth. The Auth #yyyy I provided found in the chart was denied on 11/11/25 due to the request for Inpatient evaluation of pregnancy not deemed medically necessary based on records. No test results or documentation supporting the medical need was provided which caused the authorization to deny. Per UHC policy no retro
authorizations accepted but we can submit an appeal.

I am baffled as to how to further appeal this claim. It was an uncomplicated delivery aside from Diseases of the Respiratory System Complicating Childbirth (J45.990 added for support) ... but how can they deny a hospital based delivery? And how can I further deal with this? Anyone have any suggestions?

Thank you in advance
 
debellis59 said:
Hi All.

We have appealed a denial from UHC for a 59400 (vag delivery) and have again been denied. Their reasoning:

Claim denied due to no auth. I called UHC at 1-877-797-8819 and spoke with "person" (Call reference #xxxxx) she advised that the claim denied to no auth. The Auth #yyyy I provided found in the chart was denied on 11/11/25 due to the request for Inpatient evaluation of pregnancy not deemed medically necessary based on records. No test results or documentation supporting the medical need was provided which caused the authorization to deny. Per UHC policy no retro
authorizations accepted but we can submit an appeal.

I am baffled as to how to further appeal this claim. It was an uncomplicated delivery aside from Diseases of the Respiratory System Complicating Childbirth (J45.990 added for support) ... but how can they deny a hospital based delivery? And how can I further deal with this? have any suggestions?

Thank you in advance
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I would strongly suggest and you report this to 1) ACOG, and 2) your state's insurance commissioner. Here is the Oregon site complaint form: https://sbs.naic.org/solar-web/page...m/onlineComplaintForm.jsf?state=or&dswid=5574
 
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