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Prior Authorization Reporting for Medicare Advantage Plans
Below you can find standard (non-urgent) and expedited (urgent) prior authorization request metrics for our covered Medicare Advantage members in 2025.
HMO Plans: Standard (Non-Urgent) Prior Authorization Requests
In 2025, we received a total of 29,672 standard (non-urgent) prior authorization requests for our covered HMO Medicare Advantage members. 94% of those requests were approved.
The mean (average) time it took to make standard prior authorization decisions was 2.3 days.
The median (middle) time it took to make standard prior authorization decisions was 1 days.
HMO Plans: Standard (Non-Urgent) Prior Authorization Requests by the Numbers
| How Many Times This Happened | Out of Total Requests | Percentage | |
|---|---|---|---|
| Request Approved | 27,863 | 29,672 | 94% |
| Request Denied | 1.809 | 29,672 | 6% |
| Request Approved After Timeframe was Extended | 0 | 0 | 0% |
| Request Approved Only After Appeal | 182 | 325 | 56% |
HMO Plans: Expedited (Urgent) Prior Authorization Requests
In 2025, we received a total of 207 expedited (urgent) prior authorization requests for our covered HMO Medicare Advantage members. 87% of those requests were approved.
The mean (average) time it took to make expeditated prior authorization decisions was 0.8 days.
The median (middle) time it took to make expedited prior authorization decisions was 0 days.
HMO Plans: Expedited (Urgent) Prior Authorization Requests by the Numbers
| How Many Times This Happened | Out of Total Requests | Percentage | |
|---|---|---|---|
| Request Approved | 180 | 207 | 87% |
| Request Denied | 27 | 207 | 13% |
| Request Approved After Timeframe was Extended | 0 | 0 | 0% |
PPO Plans: Standard (Non-Urgent) Prior Authorization Requests
In 2025, we received a total of 6,048 standard (non-urgent) prior authorization requests for our covered Medicare Advantage members. 94% of those requests were approved.
The mean (average) time it took to make standard prior authorization decisions was 2 days.
The median (middle) time it took to make standard prior authorization decisions was 1 days.
PPO Plans: Standard (Non-Urgent) Prior Authorization Requests by the Numbers
| How Many Times This Happened | Out of Total Requests | Percentage | |
|---|---|---|---|
| Request Approved | 5,664 | 6,048 | 94% |
| Request Denied | 384 | 6,048 | 6% |
| Request Approved After Timeframe was Extended | 0 | 0 | 0% |
| Request Approved Only After Appeal | 38 | 76 | 50% |
PPO Plans: Expedited (Urgent) Prior Authorization Requests
In 2025, we received a total of 48 expedited (urgent) prior authorization requests for our covered Medicare Advantage members. 98% of those requests were approved.
The mean (average) time it took to make expeditated prior authorization decisions was 0.1 days.
The median (middle) time it took to make expedited prior authorization decisions was 0 days.
PPO Plans: Expedited (Urgent) Prior Authorization Requests by the Numbers
| How Many Times This Happened | Out of Total Requests | Percentage | |
|---|---|---|---|
| Request Approved | 47 | 48 | 98% |
| Request Denied | 1 | 48 | 2% |
| Request Approved After Timeframe was Extended | 0 | 0 | 0% |