State Detail
Illinois
8 plans reporting · CY 2025
Across 8 plans reporting in Illinois, standard prior authorization denial rates range from 3.7% to 16.6%, averaging 11.2%. Among plans reporting appeal outcomes, 62.2% 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 | ||||||||||||||||||||||||||
| Wellcare Medicare Advantage H5779Medicare Advantage | Centene Corporation | 14,880 | 12,406 | 2,474 | 83.4% | 16.6% | 144 | 95.1% | 4.9% | 0.0% | 100.0% | 4.0 | 2.0 | 2,434 | 2,030 | 404 | 83.4% | 16.6% | 41 | 90.2% | 9.8% | 0.0% | 100.0% | 1.0 | 1.0 | View source ↗ |
| Wellcare Medicare Advantage H1416Medicare Advantage | Centene Corporation | 106,623 | 89,358 | 17,265 | 83.8% | 16.2% | 1,252 | 95.0% | 5.0% | 0.0% | 100.0% | 4.0 | 2.0 | 14,735 | 12,387 | 2,348 | 84.1% | 15.9% | 252 | 92.9% | 7.1% | 0.0% | 100.0% | 1.0 | 1.0 | View source ↗ |
| Cook County Health | ||||||||||||||||||||||||||
| CountyCare Health Plan (Cook County Medicaid MCO)Medicaid MCO | Cook County Health | 241,756 | 217,490 | 24,266 | 90.0% | 10.0% | 889 | 24.0% | 76.0% | 93.0% | 7.0% | 0.9 | 0.3 | 35,841 | 34,596 | 1,245 | 96.5% | 3.5% | 176 | 72.2% | 27.8% | 94.6% | 5.4% | 0.9 | 0.8 | View source ↗ |
| Health Care Service Corporation | ||||||||||||||||||||||||||
| Blue Cross and Blue Shield of Illinois MedicaidMedicaid MCO | Health Care Service Corporation | — | — | — | 87.0% | 13.0% | — | 7.0% | 93.0% | 55.0% | 45.0% | 1.3 | 0.2 | — | — | — | 80.0% | 20.0% | — | — | — | — | — | 0.3 | 0.1 | View source ↗ |
| BCBS Illinois Medicare Advantage (HCSC)Medicare Advantage | Health Care Service Corporation | — | — | — | 89.0% | 11.0% | — | 80.0% | 20.0% | — | — | 1.9 | 0.8 | — | — | — | 83.0% | 17.0% | — | — | — | — | — | 1.6 | 1.3 | View source ↗ |
| Humana Inc. | ||||||||||||||||||||||||||
| Humana Benefit Plan of Illinois (H1468)Medicare Advantage | Humana Inc. | 209,665 | 193,256 | 16,409 | 92.2% | 7.8% | 291 | 67.3% | 32.6% | 0.0% | 0.0% | 1.0 | 0.0 | 3,861 | 3,372 | 489 | 87.3% | 12.7% | — | — | — | 0.0% | 0.0% | 0.4 | 0.0 | View source ↗ |
| Humana Healthy Horizons IllinoisMedicaid MCO | Humana Inc. | 15,116 | 14,552 | 564 | 96.3% | 3.7% | 6 | 66.7% | 33.3% | 0.0% | 0.0% | 0.0 | 0.0 | 243 | 232 | 11 | 95.5% | 4.5% | — | — | — | 0.0% | 0.0% | 0.2 | 0.0 | View source ↗ |
| UnitedHealth Group | ||||||||||||||||||||||||||
| UnitedHealthcare Commercial Plans - IllinoisExchange Plans | UnitedHealth Group | 183,456 | — | — | — | — | 430 | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | 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