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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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6 of 536
filings in view
46K
standard requests
5.1%
volume-weighted denial rate
6
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
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 42K 3 filings
Marketplace QHP 3K 1 filings
CHIP Managed Care 1K 1 filings
Medicare Advantage 508 1 filings

Filings

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Denial rate Volume Organization Findings
Organization
Plan
Market
St
Std reqs
Denial rate
Findings
Community First Health Plans Community First Texas Medicaid STAR+PLUS Medicaid Managed Care TX 9K 7.2% 2 Community First Health Plans Community First Texas Medicaid STAR Kids Medicaid Managed Care TX 12K 5.2% 1 Community First Health Plans Community First Texas Medicaid STAR Medicaid Managed Care TX 20K 4.7% 2 Community First Health Plans Community First CHIP CHIP Managed Care TX 1K 4.6% 1 Community First Health Plans University Community Care Plan (Marketplace) Marketplace QHP TX 3K 2.8% 2 Community First Health Plans Community First Medicare Advantage (Alamo & D-SNP) Medicare Advantage TX 508 2.6% 2