State Detail
Indiana
8 plans reporting · CY 2025
Across 8 plans reporting in Indiana, standard prior authorization denial rates range from 4.6% to 30.3%, averaging 17.2%. Among plans reporting appeal outcomes, 55.6% 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 (Indiana)Exchange Plans | Centene Corporation | 56,928 | 42,933 | 13,995 | 75.4% | 24.6% | 1,884 | 36.3% | 63.7% | 6.9% | 93.1% | 2.0 | 1.0 | 2,976 | 2,224 | 752 | 74.7% | 25.3% | 148 | 58.1% | 41.9% | 6.4% | 93.6% | 1.0 | 0.0 | View source ↗ |
| Wellcare Medicare H3499Medicare Advantage | Centene Corporation | 2,367 | 1,938 | 429 | 81.9% | 18.1% | 63 | 96.8% | 3.2% | 0.0% | 100.0% | 4.0 | 1.0 | 123 | 100 | 23 | 81.3% | 18.7% | 4 | 100.0% | 0.0% | 0.0% | 100.0% | 0.0 | 1.0 | View source ↗ |
| Humana Inc. | ||||||||||||||||||||||||||
| Humana Healthy Horizons IndianaMedicaid MCO | Humana Inc. | 26,092 | 22,791 | 3,301 | 87.3% | 12.7% | 991 | 5.3% | 94.8% | 100.0% | 0.0% | 4.0 | 1.0 | 1,722 | 1,323 | 399 | 76.8% | 23.2% | — | — | — | 0.0% | 0.0% | 2.0 | 0.5 | View source ↗ |
| The Cigna Group | ||||||||||||||||||||||||||
| Cigna Health Management, Inc. - IndianaExchange Plans | The Cigna Group | 7,963 | 5,553 | 2,410 | 69.7% | 30.3% | 179 | 60.3% | 39.7% | — | — | 3.5 | — | — | — | — | — | — | — | — | — | — | — | — | — | View source ↗ |
| Evernorth Behavioral Health, Inc. - IndianaExchange Plans | The Cigna Group | 52 | 40 | 12 | 76.9% | 23.1% | 16 | 18.8% | 81.3% | — | — | 1.6 | — | — | — | — | — | — | — | — | — | — | — | — | — | View source ↗ |
| TruAssure Insurance Company | ||||||||||||||||||||||||||
| MyTruAdvantage HMO (H6529)Medicare Advantage | TruAssure Insurance Company | 929 | 865 | 67 | 93.1% | 7.2% | 80 | 82.5% | 17.5% | — | — | 7.1 | 7.0 | 165 | 161 | 4 | 97.6% | 2.4% | 3 | 66.7% | 33.3% | — | — | 0.9 | 0.3 | View source ↗ |
| MyTruAdvantage PPO (H9042)Medicare Advantage | TruAssure Insurance Company | 2,391 | 2,282 | 109 | 95.4% | 4.6% | 163 | 89.0% | 11.0% | — | — | 7.2 | 7.1 | 397 | 378 | 19 | 95.2% | 4.8% | 8 | 100.0% | 0.0% | — | — | 6.3 | 6.0 | View source ↗ |
| UnitedHealth Group | ||||||||||||||||||||||||||
| UnitedHealthcare Commercial Plans - IndianaExchange Plans | UnitedHealth Group | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | — | 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