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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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5 of 536
filings in view
200K
standard requests
16.7%
volume-weighted denial rate
0
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
1
3
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 115K 1 filings
Medicare Advantage 78K 3 filings
CHIP Managed Care 6K 1 filings

Filings

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Denial rate Volume Organization Findings
Organization
Plan
Market
St
Std reqs
Denial rate
Findings
EmblemHealth EmblemHealth Medicaid and HARP (combined) Medicaid Managed Care NY 115K 22.5% — EmblemHealth EmblemHealth Child Health Plus CHIP Managed Care NY 6K 17.9% — EmblemHealth EmblemHealth Medicare H5991 Medicare Advantage NY 5K 14.0% — EmblemHealth EmblemHealth Medicare H5228 Medicare Advantage NY 29 13.8% — EmblemHealth EmblemHealth Medicare H3330 Medicare Advantage NY 73K 7.7% —