Kaiser Permanente

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/). - Kaiser’s 2025 posting for Southern California Medicare contract H0524 reports that 25.48% of appealed prior-authorization denials were decided in the member’s favor. (https://healthy.kaiserpermanente.org/legal-regulatory/reports/cms-prior-authorization). Please reconsider my individual request on its facts, provide the specific criteria used, and identify the credentials of any clinician who reviewed it.