The first year insurers had to show their denials

Start with the national Medicare Advantage prior-authorization record. In 2024, insurers denied 4.1 million requests for care. When patients or their clinicians appealed, 80.7 percent of those denials were reversed. The reversal rate exceeded 80 percent in each year from 2019 through 2024.

But only 11.5 percent of denials were appealed. Of every 1,000 denials, 885 did not enter the formal appeal process. Of the 115 that did, 93 were reversed.

This does not prove that any individual denial was wrong. It does show that formal review frequently changes the result and that the appeal gap deserves scrutiny.

The disclosures required by rule CMS-0057-F went live around March 31, 2026, covering calendar 2025. They are self-reported and uneven — and they are still revealing.

The spread is enormous. Across UnitedHealthcare’s 75 Medicare contracts, denial rates run from 2.3 percent to 22.8 percent — a ten-fold difference inside one company, under one rule, in one half-year file. Kaiser Permanente’s flagship Southern California Medicare contract denied 19.5 percent of standard requests; of its 27,992 denials, 310 were appealed — one in ninety — and Kaiser reversed itself on only a quarter of those.

The sickest members see the most denials. Highmark’s dual-eligible special-needs contract shows triple the denial rate of its mainline Medicare contract. Industry-wide, insurers denied 65 percent of prior-authorization requests for long-term care hospitals and 54 percent for inpatient rehabilitation — against under 8 percent overall.

The rule requires each insurer to post its metrics on its own public website. Of the ten major insurer organizations in the pilot, three published complete, usable data. Cigna disclosed percentages without a single request count. Several organizations scattered files across subsidiary websites with no corporate index, some on servers that reject archival tools. Highmark published detailed counts but repeated one table across three contracts. BCBS Michigan was initially missed by our search protocol; we corrected that finding on July 9, 2026.

Only one insurer of the ten, Kaiser Permanente, published a file software could open and check directly.

The source postings refresh each March 31. We are checking the 2025 reports now and collecting the next year of activity during 2026. We label the activity year and the date we checked each source so readers can see which record they are using.