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02 · Explorer

Prior authorization denial rates, plan by plan

Every plan that published a CY2025 filing. Search for an insurer or a plan by name, narrow by state or market, and the charts and the weighted rate below recompute as you go.

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8 of 536
filings in view
297K
standard requests
21.1%
volume-weighted denial rate
4
with validation findings

The weighted rate is computed over filings in view that published both a request total and a denial count; the request figure beside it counts every filing in view.

Distribution of denial rates
filings per 10-point band
6
1
1
0–10%
10–20%
20–30%
30–40%
40–50%
50–65%
Denial rate vs. request volume
log volume, 1K → 500K · orange marks carry findings
1K10K100K500K
Request volume by market, current filter
Medicaid Managed Care 259K 4 filings
Medicare Advantage 31K 2 filings
CHIP Managed Care 7K 2 filings

Filings

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Denial rate Volume Organization Findings
Organization
Plan
Market
St
Std reqs
Denial rate
Findings
AmeriHealth Caritas Family of Companies AmeriHealth Caritas Delaware CHIP CHIP Managed Care DE 3K 48.4% 1 AmeriHealth Caritas Family of Companies AmeriHealth Caritas Delaware (Medicaid) Medicaid Managed Care DE 71K 28.3% — AmeriHealth Caritas Family of Companies Keystone First CHIP CHIP Managed Care PA 4K 19.9% — AmeriHealth Caritas Family of Companies AmeriHealth Caritas District of Columbia Medicaid Managed Care DC 99K 19.1% — AmeriHealth Caritas Family of Companies AmeriHealth Caritas New Hampshire Medicaid Managed Care NH 17K 18.8% 2 AmeriHealth Caritas Family of Companies First Choice by Select Health of South Carolina Medicaid Managed Care SC 72K 18.3% 1 AmeriHealth Caritas Family of Companies AmeriHealth Caritas VIP Care (Pennsylvania) Medicare Advantage PA 25K 17.2% — AmeriHealth Caritas Family of Companies AmeriHealth Caritas VIP Care (Michigan) Medicare Advantage MI 6K 16.4% 1