Filing · f0364
LINE OF BUSINESS: MARKETPLACE 27248
LINE OF BUSINESS: MARKETPLACE 27248 · Marketplace QHP ·
In 2025 this plan received 16,505 standard prior authorization requests and denied 22.0% of them. The median for Marketplace QHP plans of comparable size is 17.6%.
Standard denial rate
22.0%
16,505 standard requests, 3,628 denied.
37.8% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 16,505 | 12,877 | 3,628 | 22.0% |
| Expedited | 3,571 | 2,873 | 698 | 19.6% |
| Extended review, approved | 17 | |||
This payer also printed its own standard denial rate: 22.0%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 352 |
| Denials overturned | 133 |
| Overturn rate | 37.8% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | — | — |
| Expedited | — | — |