Filing · f0635
Wellcare
Wellcare · Medicare Advantage · H1416 ·
In 2025 this plan received 106,623 standard prior authorization requests and denied 16.2% of them. The median for Medicare Advantage plans of comparable size is 10.5%.
Standard denial rate
16.2%
106,623 standard requests, 17,265 denied.
95.0% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 106,623 | 89,358 | 17,265 | 16.2% |
| Expedited | 14,735 | 12,387 | 2,348 | 15.9% |
| Extended review, approved | 0 | |||
This payer also printed its own standard denial rate: 16.2%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 1,252 |
| Denials overturned | 1,189 |
| Overturn rate | 95.0% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 4.0 d | 2.0 d |
| Expedited | 24.0 h | 24.0 h |