Medicare Advantage insurers ranked by prior authorization denial rates | 2023

Centene and CVS Health had the highest rates of prior authorization denials in 2023, according to a report from KFF

The report, published Jan. 29, analyzed data submitted to CMS by Medicare Advantage insurers in 2023, the latest year for which data is available. 

On average, MA plans denied 6.4% of prior authorization requests in 2023. MA plans requested 1.8 prior authorization determinations per beneficiary in 2023. 

Individual insurers had largely similar rates of prior authorization requests and denial rates in 2023 and 2022. Centene's rates of denials increased from 9.5% in 2022 to 13.6% in 2023, while CVS Health's denial rates decreased to 11% from 13%. 

Around 1 in 10 denied prior authorization requests were appealed in 2023. Cigna had the highest appeal rate, with 18% of denied requests reappealed. 

The majority of appealed decisions, around 4 in 5, were eventually approved. Centene had the highest rate of overturned appeals, at 93.6%. 

Here's how major MA insurers compare on the number of prior authorizations, denial rates, appeal rates and overturn rates: 

Average number of prior authorization requests, per member (2023) 

Humana: 3.1 

Anthem/Elevance Health: 3.1 

Centene: 2.4 

Blue Cross Blue Shield plans: 2.3 

All other plans: 2.1 

Cigna: 1.9 

CVS Health: 1.3 

UnitedHealthcare: 1.0 

Kaiser Permanente: 0.5 

 

Prior authorization denial rates (2023) 

Centene: 13.6% 

CVS Health: 11% 

Kaiser Permanente: 10% 

UnitedHealthcare: 9.1% 

Cigna: 7.7% 

Blue Cross Blue Shield: 5.8% 

Other: 5.3% 

Anthem/Elevance Health: 4.3% 

Humana: 3.5% 

 

Share of denied prior authorization requests appealed (2023) 

Cigna: 18.0% 

CVS Health: 16.8% 

UnitedHealthcare: 15.5% 

Blue Cross Blue Shield: 10.4% 

Humana: 9.1% 

Centene: 8.8% 

Other: 8.8% 

Anthem/Elevance Health: 6.4% 

Kaiser Permanente: 1.7% 

 

Share of appealed prior authorizations overturned (2023)

Centene: 93.6% 

CVS Health: 89.7% 

Cigna: 86.0% 

UnitedHealthcare: 85.2% 

Blue Cross Blue Shield: 80.7% 

Anthem/Elevance Health: 71.1% 

Other: 69.8% 

Humana: 64.9% 

Kaiser Permanente: 42.4% 

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