Filing · f0128
Ambetter from Buckeye Health Plan
Centene · Marketplace QHP · OH · CY2025
In 2025 this plan received 52,991 standard prior authorization requests and denied 28.4% of them. The median for Marketplace QHP plans of comparable size is 18.3%.
Standard denial rate
28.4%
52,991 standard requests, 15,037 denied.
56.9% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 52,991 | 37,954 | 15,037 | 28.4% |
| Expedited | 3,499 | 2,657 | 842 | 24.1% |
This payer also printed its own standard denial rate: 28.4%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 441 |
| Denials overturned | 251 |
| Overturn rate | 56.9% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 4.0 d | 2.0 d |
| Expedited | 24.0 h | 0.0 h |