Geisinger Health Plan MA

Contract: H1298 · Plan type: HMO

Evidence lead: Ranks seven through ten · High overturn-rate cohort

Geisinger Health Plan MA: One of the ten highest appeal overturn rates

77.0% of this contract's filed appeals were overturned in the source record. Its overturn-rate rank is #7 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 seven through ten · High overturn-rate cohort

One of the ten highest appeal overturn rates

77.0% of this contract's filed appeals were overturned in the source record. Its overturn-rate rank is #7 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 seven through ten · Broad reversal reach

Overturned appeals covered a top-ten share of denials

422 overturned appeals equal 11.5% of every denial recorded for this contract. The cross-contract rank is #7 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 twenty-six through thirty · Lower-middle denial cohort

Below the center of the denial-rate ordering

At 5.8%, this contract sits in the lower-middle part of the observed distribution. The exact rank is #29 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.

Ranks twenty-six through thirty · Moderate request-volume cohort

A mid-lower authorization workload

This contract's 63,000 requests form a moderate comparison base within the table. Its request-volume rank is #28 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 twenty-six through thirty · Lower-middle appeal uptake

Appeal filing trailed the table midpoint

Filed appeals account for 15.0% of this contract's denials, or 548 records. That is rank #28 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.

Prior Authorization Scorecard

PA Requests
63,000
PA Denial Rate
5.8%
Appeals Filed
548
Appeal Overturn Rate
77.0%

Detailed Metrics

Metric Value
Prior Authorization Requests 63,000
PA Approved 59,346
PA Denied 3,654
Appeals Filed 548
Appeals Overturned 422
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 Geisinger Health Plan MA
What does Geisinger Health Plan MA's overturn rate mean? Of the appeals filed after denials in this source record, 77% were overturned (422 of 548 filed appeals, not all 3,654 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.