Becker’s Healthcare: Medicare Advantage insurers ranked by prior auth denial overturn rates

Author:  Jakob Emerson

August 13, 2024

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%

This article was originally published on Becker’s Healthcare.