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Prior Authorization Reporting for Qualified Health Plans
Below you can find standard (non-urgent) and expedited (urgent) prior authorization request metrics for our covered Qualified Health Plan members in 2025.
Standard (Non-Urgent) Prior Authorization Requests
In 2025, we received a total of 9,251 standard (non-urgent) prior authorization requests for our covered Individual ACA members. 92% of those requests were approved.
The mean (average) time it took to make standard prior authorization decisions was 1.4 days.
The median (middle) time it took to make standard prior authorization decisions was 0 days.
Standard (Non-Urgent) Prior Authorization Requests by the Numbers
| How Many Times This Happened | Out of Total Requests | Percentage | |
|---|---|---|---|
| Request Approved | 8,478 | 9,251 | 92% |
| Request Denied | 773 | 9,251 | 8% |
| Request Approved After Timeframe was Extended | 3 | 5 | 60% |
| Request Approved Only After Appeal | 16 | 18 | 89% |
Expedited (Urgent) Prior Authorization Requests
In 2025, we received a total of 485 expedited (urgent) prior authorization requests for our covered Individual ACA members. 71% of those requests were approved.
The mean (average) time it took to make expeditated prior authorization decisions was 0.7 days.
The median (middle) time it took to make expedited prior authorization decisions was 0 days.
Expedited (Urgent) Prior Authorization Requests by the Numbers
| How Many Times This Happened | Out of Total Requests | Percentage | |
|---|---|---|---|
| Request Approved | 346 | 485 | 71% |
| Request Denied | 139 | 485 | 29% |
| Request Approved After Timeframe was Extended | 0 | 0 | 0% |