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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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6 of 536
filings in view
22K
standard requests
5.1%
volume-weighted denial rate
1
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
4
2
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 12K 4 filings
Medicare-Medicaid Plan 10K 1 filings
Marketplace QHP 182 1 filings

Filings

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Denial rate Volume Organization Findings
Organization
Plan
Market
St
Std reqs
Denial rate
Findings
Point32Health Harvard Pilgrim Health Care – New Hampshire Exchange Local Choice Marketplace QHP NH 182 15.9% 1 Point32Health Tufts Health RITogether Medicaid Managed Care RI 352 15.6% — Point32Health Tufts Health Together Managed Care Organization (MCO) Medicaid Managed Care MA 2K 7.4% — Point32Health Tufts Health Together with UMass Memorial Health Medicaid Managed Care MA 6K 5.2% — Point32Health Tufts Health One Care Medicare-Medicaid Plan MA 10K 4.5% — Point32Health Tufts Health Together with Cambridge Health Alliance (CHA) Medicaid Managed Care MA 4K 4.0% —