State Detail

Delaware

4 plans reporting · CY 2025

Across 4 plans reporting in Delaware, standard prior authorization denial rates range from 1.0% to 27.7%, averaging 16.1%. Among plans reporting appeal outcomes, 50.8% 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
Centene Corporation
Ambetter Health of DelawareExchange Plans	Centene Corporation	2,946	2,131	815	72.3%	27.7%	35	31.4%	68.6%	2.5%	97.5%	5.0	4.0	168	132	36	78.6%	21.4%	6	33.3%	66.7%	0.0%	100.0%	1.0	1.0	View source ↗
Wellcare Medicare Advantage (H4661)Medicare Advantage	Centene Corporation	597	455	142	76.2%	23.8%	32	96.9%	3.1%	0.0%	0.0%	4.0	2.0	113	104	9	92.0%	8.0%	8	100.0%	0.0%	0.0%	0.0%	0.0	0.0	View source ↗
Highmark
Highmark DE DSNP Medicare Advantage (H7710)Medicare Advantage	Highmark	671	588	83	88.0%	12.0%	—	—	—	100.0%	0.0%	4.8	5.0	41	37	4	90.0%	10.0%	—	—	—	0.0%	100.0%	0.5	0.5	View source ↗
Delaware Medicaid/CHIP FFS (via Highmark)Medicaid FFS	Highmark	32,291	31,809	482	99.0%	1.0%	156	24.0%	76.0%	90.0%	10.0%	3.8	4.0	1,098	1,060	38	97.0%	3.0%	8	25.0%	75.0%	90.0%	10.0%	1.7	1.5	View source ↗