Filing · f0385
MetroPlus Medicare (H0423)
MetroPlus Health Plan · Medicare Advantage · NY · H0423 · CY2025
In 2025 this plan received 9,642 standard prior authorization requests and denied 12.0% of them. The median for Medicare Advantage plans of comparable size is 10.5%.
Standard denial rate
12.0%
9,642 standard requests, 1,160 denied.
51.2% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 9,642 | 8,482 | 1,160 | 12.0% |
| Expedited | 299 | 219 | 80 | 26.8% |
| Extended review, approved | 25 | |||
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 | 172 |
| Denials overturned | 88 |
| Overturn rate | 51.2% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 2.3 d | 0.1 d |
| Expedited | 34.3 h | 20.9 h |