Filing · f0273

Highmark QHP (federal Marketplace) - West Virginia

Highmark · Marketplace QHP · WV · Jan 1, 2025 - Dec 31, 2025

In 2025 this plan received 25,350 standard prior authorization requests and denied 11.8% of them. The median for Marketplace QHP plans of comparable size is 18.3%. One check flagged this filing.

Standard denial rate

11.8%

25,350 standard requests, 2,998 denied. 35.0% of appealed denials were overturned.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	25,350	22,352	2,998	11.8%
Expedited	6,408	5,806	602	9.4%

This payer also printed its own standard denial rate: 12.0%. The rate above is computed from the published counts, so the two can be compared.

Appeals of standard denials

Appeals filed	20
Denials overturned	7
Overturn rate	35.0%

Turnaround

	Mean	Median
Standard	0.4 d	0.0 d
Expedited	13.4 h	0.0 h

What the checks found

warnexpedited_slower_than_standard

expedited mean 13.4h exceeds standard mean 0.41d (10h)

Highmark Medicare Advantage contract H3916	3.9%
Highmark Medicare Advantage contract H3957	3.3%
Highmark QHP (federal Marketplace) - Pennsylvania	6.1%
Highmark Medicare Advantage contract H5106	5.2%
Highmark Medicare Advantage contract H3384	1.5%
Highmark Medicaid - Delaware	1.5%
Highmark Medicare Advantage contract H8166	4.1%
Highmark Medicare Advantage contract H5526	1.4%