State Detail
Ohio
8 plans reporting · CY 2025
Across 8 plans reporting in Ohio, standard prior authorization denial rates range from 5.4% to 28.4%, averaging 12.4%. Among plans reporting appeal outcomes, 60.7% 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 Buckeye Health PlanExchange Plans | Centene Corporation | 52,991 | 37,954 | 15,037 | 71.6% | 28.4% | 441 | 56.9% | 43.1% | 1.4% | 98.6% | 4.0 | 2.0 | 3,499 | 2,657 | 842 | 75.9% | 24.1% | 61 | 49.2% | 50.8% | 0.0% | 100.0% | 1.0 | 0.0 | View source ↗ |
| Wellcare Medicare Advantage (H0908)Medicare Advantage | Centene Corporation | 19,207 | 16,326 | 2,881 | 85.0% | 15.0% | 300 | 97.3% | 2.7% | 0.0% | 100.0% | 4.0 | 2.0 | 775 | 673 | 102 | 86.8% | 13.2% | 20 | 95.0% | 5.0% | 0.0% | 100.0% | 0.0 | 0.0 | View source ↗ |
| Humana Inc. | ||||||||||||||||||||||||||
| Humana Healthy Horizons OhioMedicaid MCO | Humana Inc. | 61,339 | 52,099 | 9,240 | 84.9% | 15.1% | 541 | 17.2% | 82.8% | 0.0% | 0.0% | 1.0 | 1.0 | 3,296 | 2,692 | 604 | 81.7% | 18.3% | — | — | — | 0.0% | 0.0% | 0.4 | 0.1 | View source ↗ |
| Medical Mutual of Ohio | ||||||||||||||||||||||||||
| Medical Mutual of Ohio QHPExchange Plans | Medical Mutual of Ohio | 9,251 | 8,511 | 740 | 92.0% | 8.0% | 18 | 89.0% | 11.0% | — | — | 1.4 | — | 485 | 344 | 141 | 71.0% | 29.0% | — | — | — | — | — | 0.7 | — | View source ↗ |
| Medical Mutual of Ohio Medicare HMOMedicare Advantage | Medical Mutual of Ohio | 29,672 | 27,892 | 1,780 | 94.0% | 6.0% | 325 | 56.0% | 44.0% | — | — | 2.3 | — | 207 | 180 | 27 | 87.0% | 13.0% | — | — | — | — | — | 0.8 | — | View source ↗ |
| Medical Mutual of Ohio Medicare PPOMedicare Advantage | Medical Mutual of Ohio | 6,048 | 5,685 | 363 | 94.0% | 6.0% | 76 | 50.0% | 50.0% | — | — | 2.0 | — | 48 | 47 | 1 | 98.0% | 2.0% | — | — | — | — | — | 0.1 | — | View source ↗ |
| Paramount Health Care | ||||||||||||||||||||||||||
| Paramount Insurance Company QHPExchange Plans | Paramount Health Care | 990 | 838 | 152 | 84.6% | 15.4% | 93 | 39.8% | 60.2% | — | — | 5.5 | 3.0 | 110 | 107 | 3 | 97.3% | 2.7% | — | — | — | — | — | 0.5 | 0.2 | View source ↗ |
| Paramount Health Care Medicare AdvantageMedicare Advantage | Paramount Health Care | 29,660 | 28,066 | 1,594 | 94.6% | 5.4% | 462 | 79.7% | 20.3% | — | — | 3.4 | 0.8 | 1,096 | 1,077 | 19 | 98.3% | 1.7% | — | — | — | — | — | 0.8 | 0.2 | 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