Who says no, and what happens next
76,914 standard requests were denied across the 11 filings in Unclassified that publish counts (of 11), a 19.9% rateⓘ. Four ways to read that number: whether urgent requests fare better or worse and how long decisions take, who issued the denials, whether size changes the rate, and how many denials were ever tested on appeal.
When the request is urgent
Expedited requests are the ones a doctor marked as time-critical, and the rule puts a clock on both kinds of decisionⓘ. Four pictures of what payers published against it: how long standard and expedited decisions actually take, whether urgent requests are denied more often than routine ones, and whether a filing's own mean and median tell the same story.
The filings behind the charts
Expedited denied more often than standard, the widest gaps
Against the clock, and against themselves
Organizations, by denials issued
Standard denials summed across every filing the organization published that carries counts. The rate beside each is that organization's own volume-weighted rate.
Plans with the most denials
Denial rate by stateⓘ
click a state for its filingsDoes a bigger plan say no more often?
Every filing with 100 or more standard requests: request volume across (log scale), denial rate up, coloured by market. A plan far above its neighbours of the same size and market is the one to read.
Highest for their sizeⓘ
Most denials are never tested
Among filings that publish appeal counts (11 of them), 6.8% of standard denials were appealedⓘ, and 47.3% of those appeals overturned the denial. An overturn rate describes the denials someone fought; the denials nobody fought are the larger number, and it is listed here.
Everything on this page is computed from the published counts in the filings; the plan pages show the source document for each figure. Where a plan published a rate without counts it cannot appear here, because a rate nobody can check is not a number of denials.