State Detail
District of Columbia
1 plan reporting · CY 2025
Across 1 plan reporting in District of Columbia, standard prior authorization denial rates range from 45.0% to 45.0%, averaging 45.0%. Among plans reporting appeal outcomes, 14.0% 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 |
| MedStar Health | ||||||||||||||||||||||||||
| MedStar Family Choice District of ColumbiaMedicaid MCO | MedStar Health | 30,557 | 16,806 | 13,751 | 55.0% | 45.0% | 35 | 14.0% | 86.0% | 1.0% | 6.0% | 2.0 | 1.0 | 595 | 508 | 87 | 85.0% | 15.0% | 0 | — | — | 28.0% | 0.0% | 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