Insurer record · Medicare Advantage · 32 contracts · Medicaid in 9 states
of MA prior-authorization requests denied in 2024 — among the lowest of major insurers
Dataset: Prior-authorization denials · Medicare Advantage
Complete reports found See the public-record check →
| Measure | What the insurer reported | Note |
|---|---|---|
| Standard requests, contract H4461 | 280,178 | |
| Denied | 6.17% | 17,287 denials |
| Denials appealed | 467 | 2.7% — 97% never challenged |
| Appeals won by patients | 67.02% | 313 of 467 |
| Expedited requests denied | 9.36% | vs 6.17% standard |
| Mean decision time | 1 day standard · 5 hours expedited | |
| Reports posted | 32 MA contracts + 9 state Medicaid |
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.
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/). - Humana’s 2025 posting for Medicare contract H4461 reports that 313 of 467 appealed prior-authorization denials, or 67.02%, were decided in the member’s favor. (https://assets.humana.com/is/content/humana/Humana_H4461_Prior_Auth_Metrics_PlanYear2025pdf). Please reconsider my individual request on its facts, provide the specific criteria used, and identify the credentials of any clinician who reviewed it.
The Senate PSI report found Humana's denial rate for long-term acute care hospital stays grew 54% between 2020 and 2022, reaching more than sixteen times its overall denial rate.
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.