State Detail

Kentucky

4 plans reporting · CY 2025

Across 4 plans reporting in Kentucky, standard prior authorization denial rates range from 12.8% to 20.4%, averaging 16.9%. Among plans reporting appeal outcomes, 75.9% 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
Centene Corporation
Wellcare Medicare Advantage (H3975)Medicare Advantage	Centene Corporation	9,461	7,532	1,929	79.6%	20.4%	137	97.1%	2.9%	0.0%	0.0%	3.0	2.0	950	791	159	83.3%	16.7%	18	100.0%	0.0%	0.0%	0.0%	1.0	1.0	View source ↗
Wellcare Medicare Advantage (H9730)Medicare Advantage	Centene Corporation	86,206	69,298	16,908	80.4%	19.6%	1,131	97.7%	2.3%	0.0%	0.0%	3.0	2.0	7,549	6,309	1,240	83.6%	16.4%	141	96.5%	3.5%	0.0%	0.0%	1.0	1.0	View source ↗
WellCare of Kentucky MedicaidMedicaid MCO	Centene Corporation	357,412	304,141	53,271	85.1%	14.9%	2,364	79.7%	20.3%	0.0%	100.0%	2.0	1.0	23,700	23,003	697	97.1%	2.9%	62	71.0%	29.0%	0.0%	100.0%	1.0	0.0	View source ↗
Humana Inc.
Humana Healthy Horizons KentuckyMedicaid MCO	Humana Inc.	185,535	161,811	23,724	87.2%	12.8%	799	29.2%	70.8%	0.0%	100.0%	1.0	1.0	29,501	28,872	629	97.9%	2.1%	—	—	—	0.0%	0.0%	0.7	0.3	View source ↗