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:
- Centene: 95.3%
- Aetna: 90.8%
- Anthem BCBS: 89.2%
- UnitedHealthcare: 86.1%
- Cigna: 85.3%
- BCBS: 80.3%
- Anthem: 75.1%
- Kaiser: 69.5%
- Humana: 68.4%