Filing · f0356

Kaiser Permanente Northern California (H8794)

Kaiser Permanente · Medicare Advantage · CA · H8794 · CY2025

In 2025 this plan received 39,581 standard prior authorization requests and denied 11.3% of them. The median for Medicare Advantage plans of comparable size is 10.5%.

Standard denial rate

11.3%

39,581 standard requests, 4,486 denied. 40.3% of appealed denials were overturned.

Requests and outcomes

	Total	Approved	Denied	Denial rate
Standard	39,581	35,095	4,486	11.3%
Expedited	15,611	14,291	1,320	8.5%
Extended review, approved	2

Appeals of standard denials

Appeals filed	129
Denials overturned	52
Overturn rate	40.3%

Turnaround

	Mean	Median
Standard	1.3 d	0.9 d
Expedited	24.0 h	21.0 h

Kaiser Foundation Health Plan of Washington	6.1%
Kaiser Permanente Northern California	10.5%
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%