Filing · f0629
Wellcare
Wellcare · Medicare Advantage · H5965 ·
In 2025 this plan received 26,621 standard prior authorization requests and denied 18.5% of them. The median for Medicare Advantage plans of comparable size is 10.5%.
Standard denial rate
18.5%
26,621 standard requests, 4,915 denied.
97.6% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 26,621 | 21,706 | 4,915 | 18.5% |
| Expedited | 2,457 | 2,087 | 370 | 15.1% |
| Extended review, approved | 0 | |||
This payer also printed its own standard denial rate: 18.5%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 372 |
| Denials overturned | 363 |
| Overturn rate | 97.6% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 5.0 d | 3.0 d |
| Expedited | 24.0 h | 24.0 h |