Filing · f0109
CalOptima Health OneCare (HMO D-SNP)
CalOptima Health · Medicare Advantage · CA · CY2025
In 2025 this plan received 94,832 standard prior authorization requests and denied 1.4% of them. The median for Medicare Advantage plans of comparable size is 10.9%.
Standard denial rate
1.4%
94,832 standard requests, 1,311 denied.
30.6% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 94,832 | 93,521 | 1,311 | 1.4% |
| Expedited | 13,534 | 13,277 | 257 | 1.9% |
| Extended review, approved | 230 | |||
Appeals of standard denials
| Appeals filed | 108 |
| Denials overturned | 33 |
| Overturn rate | 30.6% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 1.8 d | 0.7 d |
| Expedited | 0.0 h | 2.4 h |