Filing · f0396
The Health Plan - Medicare HMO
The Health Plan · Medicare Advantage · WV · H3672 · CY2025
In 2025 this plan received 10,305 standard prior authorization requests and denied 7.0% of them. The median for Medicare Advantage plans of comparable size is 10.9%.
Standard denial rate
7.0%
10,305 standard requests, 722 denied.
93.5% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 10,305 | 9,583 | 722 | 7.0% |
| Expedited | 141 | 132 | 9 | 6.4% |
| Extended review, approved | 5 | |||
Appeals of standard denials
| Appeals filed | 46 |
| Denials overturned | 43 |
| Overturn rate | 93.5% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 3.4 d | 2.0 d |
| Expedited | 38.4 h | 24.0 h |