State Detail
Washington
3 plans reporting · CY 2025
Across 3 plans reporting in Washington, standard prior authorization denial rates range from 8.0% to 18.5%, averaging 14.3%. Among plans reporting appeal outcomes, 74.3% 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 (WA H5965)Medicare Advantage | Centene Corporation | 26,621 | 21,706 | 4,915 | 81.5% | 18.5% | 372 | 97.6% | 2.4% | 0.0% | 100.0% | 5.0 | 3.0 | 2,457 | 2,087 | 370 | 84.9% | 15.1% | 37 | 86.5% | 13.5% | 0.0% | 100.0% | 1.0 | 1.0 | View source ↗ |
| Wellcare Medicare Advantage (WA H0029)Medicare Advantage | Centene Corporation | 26,108 | 21,801 | 4,307 | 83.5% | 16.5% | 303 | 96.4% | 3.6% | 0.0% | 100.0% | 5.0 | 3.0 | 3,086 | 2,633 | 453 | 85.3% | 14.7% | 38 | 100.0% | 0.0% | 0.0% | 100.0% | 1.0 | 1.0 | View source ↗ |
| UnitedHealth Group | ||||||||||||||||||||||||||
| UnitedHealthcare Community Plan of Washington (Apple Health)Medicaid MCO | UnitedHealth Group | 44,673 | 41,099 | 3,574 | 92.0% | 8.0% | — | 29.0% | 71.0% | 0.0% | 100.0% | 1.8 | 1.0 | 1,067 | 1,014 | 53 | 95.0% | 5.0% | — | — | — | — | — | 1.4 | 1.0 | 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