State Detail
Alabama
6 plans reporting · CY 2025
Across 6 plans reporting in Alabama, standard prior authorization denial rates range from 2.6% to 28.5%, averaging 10.2%. Among plans reporting appeal outcomes, 40.9% of appealed denials are overturned. All data is from mandatory CMS-0057-F disclosures for calendar year 2025.
Plan Comparison
| Standard | Expedited | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Plan | Org | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days | Requests | Approved | Denied | Appr % | Denial % | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days | Source |
| Aetna/CVS Health | ||||||||||||||||||||||||||
| Aetna Better Health LA MA (H3239)Medicare Advantage | Aetna/CVS Health | — | — | — | 89.6% | 10.4% | — | 84.7% | 15.3% | — | — | 1.7 | 0.0 | — | — | — | 85.3% | 14.7% | — | — | — | — | — | 0.4 | 0.0 | View source ↗ |
| Alabama Medicaid Agency | ||||||||||||||||||||||||||
| Alabama Medicaid (FFS)Medicaid FFS | Alabama Medicaid Agency | 260,902 | 233,707 | 27,195 | 89.6% | 10.4% | — | — | — | 0.4% | 99.6% | 2.0 | 0.0 | 982 | 799 | 183 | 81.4% | 18.6% | — | — | — | — | — | 0.0 | 0.0 | View source ↗ |
| Blue Cross Blue Shield of Alabama | ||||||||||||||||||||||||||
| BCBS Alabama QHPExchange Plans | Blue Cross Blue Shield of Alabama | 80,737 | 75,513 | 5,224 | 93.5% | 6.5% | 24 | 29.2% | 70.8% | — | — | 0.9 | 0.0 | 702 | 651 | 51 | 92.7% | 7.3% | — | — | — | — | — | 0.9 | 1.0 | View source ↗ |
| BCBS Alabama ALL Kids (CHIP)CHIP | Blue Cross Blue Shield of Alabama | 26,098 | 25,341 | 757 | 97.1% | 2.9% | 8 | 0.0% | 100.0% | — | — | 3.0 | 0.0 | 52 | 51 | 1 | 98.1% | 1.9% | — | — | — | — | — | 1.1 | 1.0 | View source ↗ |
| Centene Corporation | ||||||||||||||||||||||||||
| Ambetter of AlabamaExchange Plans | Centene Corporation | 38,711 | 27,669 | 11,042 | 71.5% | 28.5% | 903 | 29.2% | 70.8% | 2.2% | 97.8% | 2.0 | 1.0 | 1,252 | 964 | 288 | 77.0% | 23.0% | 60 | 48.3% | 51.7% | 4.5% | 95.5% | 1.0 | 1.0 | View source ↗ |
| Viva Health | ||||||||||||||||||||||||||
| Viva Medicare (H0154)Medicare Advantage | Viva Health | 68,385 | 66,626 | 1,759 | 97.4% | 2.6% | 65 | 61.5% | 38.5% | 0.0% | 100.0% | 3.0 | 2.0 | 1,885 | 1,782 | 103 | 94.5% | 5.5% | — | — | — | 0.0% | 100.0% | 1.0 | 1.0 | View source ↗ |
Standard Denial Rates by Plan
Appeals Analysis
Plans in the upper-right deny frequently and have high overturn rates — suggesting inappropriate denials.
Similar Denial Rates