Independent Health MA

Contract: H5253 · Plan type: HMO

Evidence lead: Top-three record · High appeal-filing share

Independent Health MA: Appeals followed a large share of denials

454 appeals equal 15.0% of this contract's recorded denials. That is rank #1 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.

Top-three record · High appeal-filing share

Appeals followed a large share of denials

454 appeals equal 15.0% of this contract's recorded denials. That is rank #1 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.

Bottom-seven record · Smaller request-volume cohort

One of the narrower authorization records

The source records 48,000 requests here, placing the contract in the smallest-volume tier. Its request-volume rank is #31 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-one through twenty-five · Lower-middle denial cohort

Below the center of the denial-rate ordering

At 6.3%, this contract sits in the lower-middle part of the observed distribution. The exact rank is #24 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 sixteen through twenty · Upper-middle overturn cohort

Appeal overturns ran above most contracts

The observed overturn rate is 71.0%, in the upper-middle portion of the table. Its overturn-rate rank is #17 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 sixteen through twenty · Upper-middle reversal reach

Reversals covered an above-median share of denials

Overturned appeals represent 10.6% of all denials here, based on 322 reversals. The cross-contract rank is #18 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.

Prior Authorization Scorecard

PA Requests
48,000
PA Denial Rate
6.3%
Appeals Filed
454
Appeal Overturn Rate
71.0%

Detailed Metrics

Metric Value
Prior Authorization Requests 48,000
PA Approved 44,976
PA Denied 3,024
Appeals Filed 454
Appeals Overturned 322
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 Independent Health MA
What does Independent Health MA's overturn rate mean? Of the appeals filed after denials in this source record, 71% were overturned (322 of 454 filed appeals, not all 3,024 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.