For the First Time, You Can See How Often Your Insurer Says No

For years, the honest answer to "how often does my insurer deny prior authorization?" was: no one outside the company really knew. That is starting to change.

What's new

In August 2026, KFF published an analysis of newly released federal prior-authorization data — the first look of its kind across Medicare Advantage, Medicaid managed care, and Affordable Care Act marketplace plans. For the first time, denial rates can be compared across insurers and across the type of coverage you have.

Two findings stand out.

First, denial rates vary enormously from one insurer to the next. KFF found wide differences in how often plans said no, even for similar populations — variation that is hard to explain by patient need alone.

Second, denials cluster around certain kinds of care. In Medicare Advantage, requests for post-acute care — skilled nursing, inpatient rehabilitation, and long-term care hospital stays — were denied at substantially higher rates than the overall average. KFF reported that Medicare Advantage plans denied roughly 12% of standard prior-authorization requests overall, with post-acute care denied more often.

KFF was also candid about the gaps: the data is not yet detailed enough to explain every difference, and it does not cover self-insured employer plans. But the direction is clear — the black box is opening.

Why this matters to you

The takeaway is not a number to memorize. It is a shift in who holds the information.

Denials are not evenly distributed. If your care falls into a category that gets denied more often — like recovery or rehabilitation care — knowing that in advance changes how you prepare.

Variation means a denial is not destiny. If one insurer approves what another denies for similar situations, the "no" is a position, not a medical verdict. Positions can be appealed.

The disclosures are a tool. As insurers are required to publish more about approval and denial rates, you have more ground to stand on when you ask why your request was the exception.

The most useful thing you can do with a denial is treat it as reviewable. Ask for the reason in writing, find your deadline, and answer the specific criteria the plan applied. Ellen helps you do all three.

Ellen does not provide medical advice. This information is educational and is not a substitute for guidance from your healthcare provider or a review of your own plan documents.