Health Insurers With the Highest Prior Authorization Denial Rates
Under CMS Rule CMS-0057-F, every health insurer offering Medicare Advantage, Medicaid managed care, or ACA marketplace coverage must publicly disclose how often it denies prior authorization requests. This ranking shows the 25 plans with the highest denial rates from the first round of mandated disclosures, covering calendar year 2025 activity reported by March 31, 2026.
A high denial rate means a larger share of care requests — submitted by a patient's doctor — were initially rejected. The appeal overturn column shows what percentage of denials were reversed on appeal, a signal of how often the initial denial was wrong.
| # | Plan / Organization | State | Type | Denial Rate | Total Requests | Appeal Overturn |
|---|---|---|---|---|---|---|
| 1 | MedStar Family Choice District of Columbia MedStar Health | DC | Medicaid MCO | 45.0% | 30,557 | 14.0% |
| 2 | MVP Health Plan Medicaid Managed Care MVP Health Care | NY | Medicaid MCO | 42.2% | 3,663 | — |
| 3 | UnitedHealthcare Community Plan TX MMP UnitedHealth Group | TX | Medicaid MCO | 40.4% | 240 | — |
| 4 | Oklahoma OHCA Medicaid FFS (CY 2025) Oklahoma Health Care Authority | OK | Medicaid FFS | 37.7% | 549,895 | — |
| 5 | Blue Cross Complete of Michigan Blue Cross Blue Shield of Michigan | MI | Medicaid MCO | 34.9% | 243,159 | — |
| 6 | MVP Health Plan HARP MVP Health Care | NY | Medicaid MCO | 33.7% | 344 | — |
| 7 | UnitedHealthcare Community Plan MA Senior Care Options UnitedHealth Group | MA | Medicaid MCO | 33.3% | 84 | — |
| 8 | Ambetter from Superior HealthPlan TX QHP (Issuer 29418) Centene Corporation | TX | Exchange Plans | 32.9% | 218,062 | 61.9% |
| 9 | Ambetter from Superior HealthPlan TX QHP (Issuer 87226) Centene Corporation | TX | Exchange Plans | 32.5% | 89,666 | 60.1% |
| 10 | Ambetter Health (Iowa Total Care) Centene Corporation | IA | Exchange Plans | 31.1% | 3,173 | 50.5% |
| 11 | Cigna Health Management, Inc. - Indiana The Cigna Group | IN | Exchange Plans | 30.3% | 7,963 | 60.3% |
| 12 | Ambetter of Oklahoma Centene Corporation | OK | Exchange Plans | 30.1% | 38,282 | 29.9% |
| 13 | DHCS Medi-Cal Dental Fee-for-Service California Department of Health Care Services | CA | Medicaid FFS | 29.5% | 3,138,788 | 66.8% |
| 14 | Excellus BCBS Medicare DSNP HMO (H7524) Excellus BlueCross BlueShield | NY | Medicare Advantage | 29.3% | 2,327 | 22.2% |
| 15 | Ambetter of Alabama Centene Corporation | AL | Exchange Plans | 28.5% | 38,711 | 29.2% |
| 16 | Ambetter from Buckeye Health Plan Centene Corporation | OH | Exchange Plans | 28.4% | 52,991 | 56.9% |
| 17 | UnitedHealthcare QHP MO (ACA Marketplace) UnitedHealth Group | MO | Exchange Plans | 28.3% | 5,301 | — |
| 18 | Healthfirst Child Health Plus Healthfirst | NY | CHIP | 28.3% | 28,487 | 3.1% |
| 19 | Independent Health Medicaid/Essential/CHP Independent Health | NY | Medicaid MCO | 28.2% | 36,266 | — |
| 20 | DHCS Medi-Cal Fee-for-Service Medical and Behavioral Health California Department of Health Care Services | CA | Medicaid FFS | 28.0% | 78,987 | 13.9% |
| 21 | Ambetter Health of Delaware Centene Corporation | DE | Exchange Plans | 27.7% | 2,946 | 31.4% |
| 22 | Fidelis Care MLTC Centene Corporation | NY | Medicaid MCO | 27.5% | 44,469 | 28.9% |
| 23 | DHCS California Children's Services California Department of Health Care Services | CA | Medicaid FFS | 27.0% | 755,850 | 6.7% |
| 24 | Cigna Healthcare IFP FFE The Cigna Group | CO | Exchange Plans | 27.0% | — | 16.0% |
| 25 | Fidelis Care Medicaid Centene Corporation | NY | Medicaid MCO | 26.6% | 1,060,258 | 28.8% |
Showing top 25 of 564 plans with standard denial rate data. Plans without a published denial percentage are excluded. Some plans report percentages only, without raw request counts (shown as —). Rankings reflect insurer-reported figures as disclosed under CMS Rule CMS-0057-F.