Filing · f0390
Sendero Health Plans (IdealCare marketplace)
Sendero Health Plans · Marketplace QHP · TX · CY2025
This plan reported a 2.2% standard prior authorization denial rate for 2025, without publishing the underlying counts. The median for Marketplace QHP plans of comparable size is 18.3%.
Standard denial rate
2.2%
This filing published percentages without counts.
50.0% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | — | 8,659 | 188 | 2.2% |
| Expedited | — | 1,304 | 16 | 1.2% |
This payer also printed its own standard denial rate: 2.2%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 28 |
| Denials overturned | 14 |
| Overturn rate | 50.0% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 2.4 d | 1.5 d |
| Expedited | 18.8 h | 16.0 h |