Optum Behavioral Health (UBH) Appeals and Reconsiderations in California

Optum Behavioral Health (also known as United Behavioral Health, and in California as OptumHealth Behavioral Solutions of California) manages behavioral health benefits for many UnitedHealthcare members. Its appeal process is separate from UnitedHealthcare's medical process, and it runs on Provider Express.

Here is how the process works for a California facility, based on Optum's published guides.

Key points

Two steps: reconsideration first, then appeal.
Both steps must fit inside 12 months.
Reconsideration still goes by mail; appeals can go online.

The two-step process

For commercial and Medicare Advantage claims with dates of service on or after July 5, 2023, Optum Behavioral Health uses two steps. It covers medical necessity and no-authorization denials as well as administrative ones.

Step	How to send it	Decision time
1. Reconsideration	Reconsideration request form from Provider Express, sent by mail to the address on the form	Within 30 days
2. Appeal	Provider Express: Submit Claim Appeal or Submit Clinical Appeal; fax is also listed	Typically 30 to 45 days

Both steps together must fit inside 12 months, unless state law or your agreement sets another limit. Optum's National Provider Network Manual, effective September 1, 2026, still lists reconsideration by mail only.

California HMO members

Optum's notice says reconsideration may not apply in some jurisdictions, and points California commercial HMO cases to its California provider dispute section. For members of plans regulated by the Department of Managed Health Care, California's provider dispute rule applies: payers must allow at least 365 days to file, and must decide within 45 working days.

What to send

The completed reconsideration form or appeal entry, with the claim number
Treatment plans and the clinical records for the denied dates
The criteria the denial named, matched to chart evidence
Proof of timely filing
For corrected billing, a corrected claim instead of a reconsideration

UnitedHealthcare treats corrected claims as separate from reconsiderations. If the denial came from a billing error, fix the claim and resubmit it rather than spending a review step.

Criteria and the Wit case

In Wit v. United Behavioral Health, a federal court found in 2019 that UBH's level-of-care guidelines were more restrictive than generally accepted standards of care. In February 2026 the court extended an injunction requiring criteria that reflect those standards through February 3, 2031, according to The Kennedy Forum's case summary. In California, SB 855 separately requires state-regulated plans to use nonprofit clinical criteria such as The ASAM Criteria.

Practical point: when a denial cites a criteria set, check that it matches what the plan is required to use, and say so in the appeal.

If the appeal fails

Next steps depend on the plan type. State-regulated California plans lead to Independent Medical Review, filed by the member. Self-funded employer plans use federal external review. Either way you need the member's signed authorization.

Not legal advice. This guide is general education, not legal advice. Plan documents, provider contracts and state law can change the rules. Talk to a health care attorney about a specific case.

Frequently asked questions

Can I submit an Optum Behavioral Health reconsideration online?

As of Optum's National Provider Network Manual effective September 1, 2026, reconsiderations go by mail. The appeal step can be filed on Provider Express.

How long does Optum Behavioral Health take?

Optum says reconsiderations are decided within 30 days and appeals typically take 30 to 45 days.

Is a no-authorization denial eligible?

Yes. Optum's process covers medical necessity and no-authorization denials as well as administrative denials.

Sources

Last reviewed October 2026. Payer rules change; check the source before you file.

Payer Watch

Payer and denial changes, once a month.