Medicare Advantage insurers ranked by prior auth denial overturn rates

Medicare Advantage insurers ranked by prior auth denial overturn rates

https://www.beckerspayer.com/payer/medicare-advantage-insurers-ranked-by-prior-auth-denial-overturn-rates.html

Centene is the most likely to overturn a prior authorization denial decision when appealed, while Humana is the least likely, according to a KFF analysis.

Medicare Advantage insurers denied 7.4% of prior authorization requests in 2022, up from 5.8% in 2021. Among those denials, 9.9% were appealed. Among those appeals, 83.2% of denals were overturned. 

CVS Health denied the highest percentage of prior authorization requests in 2021 and 2022, denying 13% and 12% of prior authorization requests, respectively. Humana had the highest number of prior authorization requests per member in 2022, at 2.9. 

Payers ranked by prior authorization request denial overturn rates in 2022:

  1. Centene: 95.3%
  2. Aetna: 90.8%
  3. Anthem BCBS: 89.2%
  4. UnitedHealthcare: 86.1%
  5. Cigna: 85.3%
  6. BCBS: 80.3%
  7. Anthem: 75.1%
  8. Kaiser: 69.5%
  9. Humana: 68.4%

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