Filing · f0395
The Health Plan - Medicare (posted as PPO)
The Health Plan · Medicare Advantage · WV · H8604 · CY2025
In 2025 this plan received 3,514 standard prior authorization requests and denied 7.9% of them. The median for Medicare Advantage plans of comparable size is 10.9%.
Standard denial rate
7.9%
3,514 standard requests, 279 denied.
100.0% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 3,514 | 3,235 | 279 | 7.9% |
| Expedited | 74 | 72 | 2 | 2.7% |
| Extended review, approved | 2 | |||
Appeals of standard denials
| Appeals filed | 16 |
| Denials overturned | 16 |
| Overturn rate | 100.0% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 2.8 d | 1.0 d |
| Expedited | 35.3 h | 24.0 h |