Project Crossfoot
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 658
filings in view
241K
standard requests
21.3%
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 · click a bar for its filings
3
3
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 · click a point for the filing
1K10K100K500K
Request volume by market, current filter
Medicaid Managed Care 142K 4 filings
Marketplace QHP 99K 2 filings
Where the denial rate is highest
volume-weighted per state · floor 10K requests · top 10 · click a state for its filings
SC 21.3% 241K · 4 filings
Organizations by denials in view
standard denials summed over the slice · weighted rate beside each · top 10
Centene 21K 21.5%
Elevance Health 15K 27.9%
AmeriHealth Caritas Family of Companies 13K 18.3%
Humana 2K 10.9%
Rate spread by market
the box is the middle half of the market's rates, the whisker runs 10th–90th percentile, the median is marked · orange dots are the filings past the 90th · click a box for the market, a dot for the filing
0%10%20%30%40%50%60%Medicaid Managed Care4 filingsElevance Health · Healthy Blue South Carolina (BlueChoice HealthPlan of South Carolina) — 27.9%Molina Healthcare · Molina Healthcare of South Carolina Medicaid — 27.0%AmeriHealth Caritas Family of Companies · First Choice by Select Health of South Carolina — 18.3%Humana · Humana Healthy Horizons in South Carolina — 10.9%Marketplace QHP2 filingsCentene · Ambetter from Absolute Total Care (79222) — 21.5%Molina Healthcare · Molina Marketplace South Carolina — 13.0%
How concentrated the denials are
plans ranked by denials, cumulative share · the dashed diagonal is every plan equal
25%50%75%100%0%25%50%75%100%top 10% of plans → 41.4% of denials10% of plans → 41% of denialsplans, ranked by denials →share of all denials ↑
What the slice actually discloses
how much of the current view can be checked — a rate without counts is a claim, not a number
■ 4 publish counts ▨ 2 publish no counts — a rate nobody can check ● 1 carry validation findings

Filings

This view as JSON
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Denial rate Volume Organization Findings
Organization
Plan
Market
St
Std reqs
Denial rate
Findings
Elevance Health Healthy Blue South Carolina (BlueChoice HealthPlan of South Carolina) Medicaid Managed Care SC 55K 27.9% — Molina Healthcare Molina Healthcare of South Carolina Medicaid Medicaid Managed Care SC — 27.0% — Centene Ambetter from Absolute Total Care (79222) Marketplace QHP SC 99K 21.5% — AmeriHealth Caritas Family of Companies First Choice by Select Health of South Carolina Medicaid Managed Care SC 72K 18.3% 1 Molina Healthcare Molina Marketplace South Carolina Marketplace QHP SC — 13.0% — Humana Humana Healthy Horizons in South Carolina Medicaid Managed Care SC 15K 10.9% —