Contract: H1189 · Plan type: HMO
Evidence lead: Bottom-seven record · Lower denial-rate cohort
Kaiser Permanente MA's 4.2% rate belongs to the lowest-denial tier in this table. The exact rank is #37 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.
Bottom-seven record · Lower denial-rate cohort
Kaiser Permanente MA's 4.2% rate belongs to the lowest-denial tier in this table. The exact rank is #37 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.
Top-three record · High overturn-rate cohort
81.0% of this contract's filed appeals were overturned in the source record. Its overturn-rate rank is #3 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.
Top-three record · Broad reversal reach
3,164 overturned appeals equal 12.2% of every denial recorded for this contract. The cross-contract rank is #3 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 four through six · Large request-volume cohort
The 620,000 recorded requests place this contract in the highest-volume tier. Its request-volume rank is #5 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
The 3,906 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.
| Metric | Value |
|---|---|
| Prior Authorization Requests | 620,000 |
| PA Approved | 593,960 |
| PA Denied | 26,040 |
| Appeals Filed | 3,906 |
| Appeals Overturned | 3,164 |
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.