State Detail
Missouri
2 plans reporting · CY 2025
Across 2 plans reporting in Missouri, standard prior authorization denial rates range from 6.1% to 22.8%, averaging 14.5%. Among plans reporting appeal outcomes, 53.8% 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 from Home State HealthExchange Plans | Centene Corporation | 89,747 | 69,279 | 20,468 | 77.2% | 22.8% | 2,503 | 57.6% | 42.4% | 1.6% | 98.4% | 2.0 | 0.0 | 2,491 | 1,923 | 568 | 77.2% | 22.8% | 69 | 58.0% | 42.0% | 2.2% | 97.8% | 1.0 | 0.0 | View source ↗ |
| Humana Inc. | ||||||||||||||||||||||||||
| Humana Regional Health Plan (H4623)Medicare Advantage | Humana Inc. | 19,870 | 18,657 | 1,213 | 93.9% | 6.1% | 40 | 50.0% | 50.0% | 0.0% | 0.0% | 1.0 | 0.0 | 313 | 285 | 28 | 91.0% | 8.9% | — | — | — | 0.0% | 0.0% | 0.2 | 0.0 | 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