Filing · f0181
Wellcare By Health Net H3561
Centene · Medicare Advantage · CA · H3561 · CY2025
In 2025 this plan received 290,257 standard prior authorization requests and denied 2.0% of them. The median for Medicare Advantage plans of comparable size is 10.9%.
Standard denial rate
2.0%
290,257 standard requests, 5,737 denied.
77.5% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 290,257 | 284,520 | 5,737 | 2.0% |
| Expedited | 40,022 | 38,810 | 1,212 | 3.0% |
| Extended review, approved | 7 | |||
Appeals of standard denials
| Appeals filed | 120 |
| Denials overturned | 93 |
| Overturn rate | 77.5% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 3.0 d | 1.0 d |
| Expedited | 0.0 h | 24.0 h |