Insurers Deny Up to 1 in 8 Prior Authorization Requests, KFF Report Finds

A new analysis by KFF found that health insurers participating in Medicare Advantage, Medicaid managed care, and Affordable Care Act (ACA) marketplace plans denied at least one in eight standard prior authorization requests last year.

The report showed denial rates ranging from 12 percent in Medicare Advantage plans to 18 percent in ACA marketplace coverage. However, there were significant differences between insurers, with Elevance having a denial rate of 5 percent and UnitedHealth Group having a denial rate of 17 percent in Medicare Advantage plans.

KFF found that many denials are later overturned on appeal, with 67 percent of Medicare Advantage denials being reversed. However, appeals remain relatively uncommon, meaning many denials may never be challenged.