BCBS Michigan MA

Contract: H4152 · Plan type: PPO

Evidence lead: Ranks seven through ten · Large request-volume cohort

BCBS Michigan MA: One of the ten largest authorization workloads

The 310,000 recorded requests place this contract in the highest-volume tier. Its request-volume rank is #9 of 37. Volume shows the denominator behind approvals and denials; it is not a measure of plan quality, membership, benefit breadth, price, or future coverage decisions.

Ranks seven through ten · Large request-volume cohort

One of the ten largest authorization workloads

The 310,000 recorded requests place this contract in the highest-volume tier. Its request-volume rank is #9 of 37. Volume shows the denominator behind approvals and denials; it is not a measure of plan quality, membership, benefit breadth, price, or future coverage decisions.

Ranks eleven through fifteen · Upper-middle appeal uptake

Appeal filing exceeded most contract records

The 3,348 filed appeals represent 15.0% of denied requests. That is rank #11 of 37 for filing share. The ratio reports aggregate activity; it cannot reveal why an appeal was or was not filed, whether the underlying cases were comparable, or what happened outside the reporting window.

Ranks twenty-six through thirty · Lower-middle overturn cohort

Appeal overturns sat below the table midpoint

This contract records a 66.0% overturn rate among filed appeals. Its overturn-rate rank is #27 of 37. The denominator is filed appeals, not all authorization requests. The percentage therefore describes reviewed appeals and must not be read as an individual outcome forecast.

Ranks twenty-six through thirty · Lower-middle reversal reach

Reversals covered a below-median share of denials

The 2,210 recorded reversals amount to 9.9% of this contract's denied requests. The cross-contract rank is #27 of 37. This derived measure combines appeal filing and outcome, so it supplies scale context but does not identify clinical reasons, administrative errors, or coverage rules.

Ranks sixteen through twenty · Upper-middle denial cohort

Above the center of the denial-rate ordering

The recorded 7.2% denial rate falls in the upper-middle portion of the contract set. The exact rank is #18 of 37. This is aggregate prior-authorization activity for the reporting window, not a probability that a particular service, drug, or beneficiary request will be denied.

Prior Authorization Scorecard

PA Requests
310,000
PA Denial Rate
7.2%
Appeals Filed
3,348
Appeal Overturn Rate
66.0%

Detailed Metrics

Metric Value
Prior Authorization Requests 310,000
PA Approved 287,680
PA Denied 22,320
Appeals Filed 3,348
Appeals Overturned 2,210
Source: CMS Office of Inspector General report OEI-09-22-00380; KFF 2023 Medicare Advantage analysis. Verify with HHS OIG → · CMS.gov →
Sources, caveats, and related notes for BCBS Michigan MA
What does BCBS Michigan MA's overturn rate mean? Of the appeals filed after denials in this source record, 66% were overturned (2,210 of 3,348 filed appeals, not all 22,320 denied requests).
This data is for informational purposes only and does not constitute medical, financial, or insurance advice. Contact CMS or your plan for coverage decisions. Data from CMS OIG and KFF Medicare Advantage analysis.

Data: CMS OIG OEI-09-22-00380 and KFF 2023 Medicare Advantage analysis. Not affiliated with CMS. ← All MA plans

Read our methodology - how this data is sourced, computed, and verified.

Primary data: U.S. Department of Health & Human Services, Office of Inspector General, Medicare Advantage Encounter Data (Report OEI-09-22-00380, 2024). Secondary data: Kaiser Family Foundation 2023 Medicare Advantage Prior Authorization analysis. Methodology and editorial review by PlainInsurer, see methodology.