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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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23 of 536
filings in view
1.4M
standard requests
13.0%
volume-weighted denial rate
23
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
12
10
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 763K 12 filings
Medicare Advantage 367K 4 filings
Medicaid FFS 239K 4 filings
Marketplace QHP 3K 2 filings
CHIP Managed Care 1K 1 filings

Filings

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Denial rate Volume Organization Findings
Organization
Plan
Market
St
Std reqs
Denial rate
Findings
AmeriHealth Caritas Keystone First Medicaid Managed Care PA 315K 28.4% 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 (Michigan) Medicare Advantage MI 6K 16.4% 1 Point32Health Harvard Pilgrim Health Care – New Hampshire Exchange Local Choice Marketplace QHP NH 182 15.9% 1 AmeriHealth Caritas AmeriHealth Caritas North Carolina Medicaid Managed Care NC 78K 15.0% 2 Centene NH Healthy Families Medicaid Managed Care NH 40K 13.4% 1 Contra Costa Health Contra Costa Health Plan (Medi-Cal) Medicaid Managed Care CA 62K 10.9% 2 AmeriHealth Caritas AmeriHealth Caritas Louisiana Medicaid Managed Care LA 87K 10.8% 2 Wyoming Department of Health Wyoming Medicaid Utilization Management (FFS) Medicaid FFS WY 11K 10.3% 1 Mississippi Division of Medicaid Mississippi Medicaid Fee-for-Service Medicaid FFS MS 60K 10.2% 2 CareOregon Columbia Pacific CCO Medicaid Managed Care OR 16K 7.9% 2 CareOregon Jackson Care Connect Medicaid Managed Care OR 35K 7.6% 2 Community First Health Plans Community First Texas Medicaid STAR+PLUS Medicaid Managed Care TX 9K 7.2% 2 Michigan Department of Health and Human Services Michigan Medicaid Home and Community Based Services (Aging and Community Services Division, incl. Brain Injury Services and Community Transition Services) - Fee-for-Service Medicaid FFS MI 3K 5.2% 1 Community First Health Plans Community First Texas Medicaid STAR Kids Medicaid Managed Care TX 12K 5.2% 1 Geisinger Health Geisinger Health Plan (all lines of business, aggregated) Medicare Advantage PA 311K 5.1% 1 Sentara Health Sentara Health Plans - Medicare Medicare Advantage VA 50K 5.1% 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 Wisconsin Department of Health Services Wisconsin Medicaid (ForwardHealth) -- specific program/agency not named in document Medicaid FFS WI 165K 4.0% 2 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