Filing · f0297

Kaiser Permanente Northern California

Kaiser Permanente · Medicare Advantage · CA · H0524 · CY2025

In 2025 this plan received 144,514 standard prior authorization requests and denied 10.5% of them. The median for Medicare Advantage plans of comparable size is 10.9%.

Standard denial rate

10.5%

144,514 standard requests, 15,214 denied. 36.9% of appealed denials were overturned.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	144,514	129,300	15,214	10.5%
Expedited	68,652	63,529	5,123	7.5%
Extended review, approved	0

Appeals of standard denials

Appeals filed	369
Denials overturned	136
Overturn rate	36.9%

Turnaround

	Mean	Median
Standard	1.6 d	0.9 d
Expedited	25.0 h	21.0 h

Kaiser Foundation Health Plan of Washington	6.1%
Kaiser Permanente Southern California	19.5%
Kaiser Foundation Health Plan of the Mid-Atlantic States	5.5%
Kaiser Foundation Health Plan of Colorado	9.6%
Kaiser Foundation Health Plan of the Northwest	12.6%
Kaiser Permanente Southern California - Medi-Cal	6.4%
Kaiser Foundation Health Plan of Georgia	3.1%
Kaiser Permanente Northern California (H8794)	11.3%