Insurer record · Michigan Blues licensee · MA and marketplace · full data posted

Blue Cross Blue Shield of Michigan

4.2%

of 800,694 standard Medicare Plus Blue requests denied in 2025 — with 88% of appeals won by patients

Dataset: Prior-authorization postings · payers' own sites · CY2025

Complete public page See the public-record check →

From the payer’s own CY2025 posting

What Blue Cross Blue Shield of Michigan disclosed

Measure	What the insurer reported	Note
Standard requests, Medicare Plus Blue PPO	800,694
Denied	4.22%	33,752 denials
Appeals won by patients	88%	of 2,185 appeals
Urgent (expedited) requests denied	14.28%	vs 4.22% standard — urgent asks fare worse
BCN Advantage standard denial rate	4.46%	91% of appeals overturned
Individual marketplace plans denied	~6.4–6.6%
Mean decision time (standard)	0.72 days

Source · BCBS Michigan prior-authorization approval rates, CY2025

Published: 2026
Capture note: Located Jul. 9, 2026 — corrects our Jul. 8 'not located' verdict.
Public lineage: Original source linked below. A public immutable archive and provenance ID are not yet published.

Open original source ↗

Appeal drafting · free to use

Denied by Blue Cross Blue Shield of Michigan? Build a fact-specific draft.

Start with the facts in your notice. The builder adds public context only when it matches Medicare Advantage prior authorization, and labels that context so it is not confused with evidence about your individual request.

Write my appeal letter

The block below is for Medicare Advantage prior-authorization appeals only.

I ask that my Medicare Advantage prior-authorization appeal be reviewed carefully. I include the following public figures as background only; they do not describe my individual request and do not, by themselves, show that this denial was incorrect: - KFF's analysis of insurer-reported CMS data found that 80.7% of appealed Medicare Advantage prior-authorization denials were overturned in 2024. CMS does not audit these insurer submissions (https://www.kff.org/medicare/medicare-advantage-insurers-made-nearly-53-million-prior-authorization-determinations-in-2024/). - Blue Cross Blue Shield of Michigan’s 2025 posting for Medicare Plus Blue PPO reports that 88% of 2,185 appealed prior-authorization denials were decided in the member’s favor. (https://www.bcbsm.com/important-information/prior-auth-approval-rates/). Please reconsider my individual request on its facts, provide the specific criteria used, and identify the credentials of any clinician who reviewed it.

On the record

Correction: we called this 'not located.' It wasn't.

Our July 8 pilot audit reported BCBS Michigan's posting as not located after searching its provider pages and search engines. The data was on a consumer help page our protocol missed. We corrected the verdict on July 9, fixed the protocol (consumer paths and subsidiary domains are now mandatory search targets), and log the correction here permanently.

Source · BCBS Michigan prior-authorization approval rates, CY2025

Published: 2026
Capture note: Located Jul. 9, 2026 — corrects our Jul. 8 'not located' verdict.
Public lineage: Original source linked below. A public immutable archive and provenance ID are not yet published.

Open original source ↗

Its marketplace claim denials are mid-pack.

On the separate claim-denial measure, BCBS Michigan denied 17% of in-network marketplace claims in 2024 — 15th of the nineteen largest parents.

Source · KFF analysis of the CMS Transparency in Coverage PUF (2024 plan year)

Published: Mar. 24, 2026
Capture note: HealthCare.gov states only; CMS does not audit insurer submissions.
Public lineage: Original source linked below. A public immutable archive and provenance ID are not yet published.

Open original source ↗

See how these figures are collected, what they can and cannot tell you, and how to request a correction on the methodology page. Compare payers on the rankings page.