Filing · f0384
San Francisco Health Plan (Medi-Cal)
San Francisco Health Plan · Medicaid Managed Care · CA · CY2025
In 2025 this plan received 62,848 standard prior authorization requests and denied 2.0% of them. The median for Medicaid Managed Care plans of comparable size is 13.2%.
Standard denial rate
2.0%
62,848 standard requests, 1,242 denied.
54.6% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 62,848 | 61,606 | 1,242 | 2.0% |
| Expedited | 15,523 | 15,125 | 398 | 2.6% |
| Extended review, approved | 37 | |||
Appeals of standard denials
| Appeals filed | 130 |
| Denials overturned | 71 |
| Overturn rate | 54.6% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 4.7 d | 6.0 d |
| Expedited | 10.9 h | 7.5 h |