Filing · f0646
Wellcare
Wellcare · Medicare Advantage · H4868 ·
In 2025 this plan received 90,696 standard prior authorization requests and denied 20.8% of them. The median for Medicare Advantage plans of comparable size is 10.5%.
Standard denial rate
20.8%
90,696 standard requests, 18,905 denied.
92.7% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 90,696 | 71,791 | 18,905 | 20.8% |
| Expedited | 12,416 | 10,853 | 1,563 | 12.6% |
| Extended review, approved | 0 | |||
This payer also printed its own standard denial rate: 20.8%. The rate above is computed from the published counts, so the two can be compared.
Appeals of standard denials
| Appeals filed | 1,182 |
| Denials overturned | 1,096 |
| Overturn rate | 92.7% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 4.0 d | 2.0 d |
| Expedited | 24.0 h | 24.0 h |