Payers & Insurers Denied Between 12% To 18% Of Prior Authorization Requests In 2025

Between 12% and 18% of requests for prior authorization for non-urgent care were denied in 2025. Expedited prior authorization requests for urgent service needs had a slightly lower denial rate. Although plan members rarely appeal a prior authorization denial, when they did, in 2025, more than 40% of denials were reversed.

Medicare Advantage plans denied 12% of standard prior authorization requests, and 10% of expedited requests. About 67% of appealed denials were overturned.

Medicaid managed care insurers denied 14% of standard requests, and 12% of expedited requests. About 47% of appealed denials were overturned.

Affordable Care Act (ACA) Marketplace . . .