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Elevance Health — Denial Rates & Appeal Data

Name: Elevance Health prior authorization denial metrics
Creator: Coverage Rights

Medicare AdvantageMedicaid MCOMarketplace QHPCommercialReporting year 2025

Compare against every insurer we track: denial rates ranked within reporting cohorts.

Prior-auth denial rate

4.5%

of Medicare Advantage contracts requests denied

Appeal overturn rate

79.7%

of appealed Medicare Advantage contracts denials reversed

COVERAGE RIGHTS ROLLUP · CALCULATED FROM ELEVANCE HEALTH PUBLIC DISCLOSURES

Elevance posts per-plan scorecards across its Anthem/Wellpoint/Simply brand sites; Medicare Advantage scorecards are percentages-only. Rates shown are enrollment-weighted averages of Elevance's own posted per-contract figures across 23 MA contracts covering ~1.2M enrollees (weights: CMS Monthly Enrollment by Contract, July 2026; 3 contracts lacked published enrollment). Medicaid and marketplace plans are reported separately per state and are not included in this rollup.

UNDERLYING SOURCE: ELEVANCE HEALTH CMS-0057-F DISCLOSURE, CY2025 · VIEW SOURCE ↗ · METHODOLOGY

Metrics by contract / plan

Elevance Health’s own CY2025 CMS-0057-F disclosures, plan by plan. Standard-request figures; every row links to its source.

Elevance Health CY2025 prior authorization metrics by contract or plan
Contract / plan	Line	Requests	Denied	Appeals overturned	Avg decision	Source
IN-HIP · IN Anthem	Medicaid	425,335	8.1%	22.1%	1d	Source
IN-Pathways · IN Anthem	Medicaid	403,669	1.5%	61.37%	7d	Source
IN-HHW · IN Anthem	Medicaid	122,312	6.8%	49.4%	1d	Source
IN-HCC · IN Anthem	Medicaid	102,444	9%	50.8%	1d	Source
FL-CHIP · FL Simply	Medicaid	n/r	24.5%	18.6%	5d	Source
MD-Medicaid · MD Wellpoint	Medicaid	n/r	20%	51.5%	1d	Source
WV-Medicaid · WV Wellpoint	Medicaid	n/r	17.6%	26.9%	2d	Source
NV-Medicaid · NV Anthem	Medicaid	n/r	16.4%	30.4%	3d	Source
FL-Medicaid · FL Simply	Medicaid	n/r	12%	35.7%	1d	Source
NY-CHIP · NY Anthem	Medicaid	n/r	11.6%	42.5%	3d	Source
VA-Medicaid · VA Anthem	Medicaid	n/r	11.1%	28.3%	3d	Source
NJ-Medicaid · NJ Wellpoint	Medicaid	n/r	10.3%	41.6%	5d	Source
WA-Medicaid · WA Wellpoint	Medicaid	n/r	10.3%	27.9%	2d	Source
H2441 · VA Anthem	Medicare Advantage	n/r	10%	83%	2d	Source
H4704 · CA Anthem	Medicare Advantage	n/r	9.2%	56%	2d	Source
R4487 Anthem	Medicare Advantage	n/r	9.2%	80%	2d	Source
TX-Medicaid · TX Wellpoint	Medicaid	n/r	8.6%	31.4%	1d	Source
TN-Medicaid · TN Wellpoint	Medicaid	n/r	8.5%	19.5%	3d	Source
H5422 · GA Anthem	Medicare Advantage	n/r	6.5%	77%	3d	Source
H3655 · OH Anthem	Medicare Advantage	n/r	6.3%	79%	2d	Source
H5854 · CT Anthem	Medicare Advantage	n/r	6.2%	70%	2d	Source
H3536 · NH Anthem	Medicare Advantage	n/r	5.9%	80%	2d	Source
H4346 Anthem	Medicare Advantage	n/r	5.6%	79%	2d	Source
H9525 Anthem	Medicare Advantage	n/r	5.3%	78%	2d	Source
H4036 Anthem	Medicare Advantage	n/r	5.2%	79%	2d	Source
H3447 Anthem	Medicare Advantage	n/r	5%	78%	3d	Source
H8552 · CA Anthem	Medicare Advantage	n/r	5%	84%	2d	Source
H4694 · VA Anthem	Medicare Advantage	n/r	4.6%	71%	3d	Source
H7093 · IN Anthem	Medicare Advantage	n/r	4.5%	81%	2d	Source
IA-Medicaid · IA Wellpoint	Medicaid	n/r	4.4%	41.6%	2d	Source
H1607 · IN Anthem	Medicare Advantage	n/r	4.2%	77%	2d	Source
H2836 · CT Anthem	Medicare Advantage	n/r	4.1%	76%	2d	Source
H3342 · NY Anthem	Medicare Advantage	n/r	3.7%	75%	2d	Source
R5941 Anthem	Medicare Advantage	n/r	3.7%	80%	2d	Source
H9219 · ME Anthem	Medicare Advantage	n/r	3.6%	50%	2d	Source
H4909 Anthem	Medicare Advantage	n/r	3.4%	85%	2d	Source
H9065 · ME Anthem	Medicare Advantage	n/r	3%	90.3%	2d	Source
CA-Medicaid · CA Anthem	Medicaid	n/r	2.6%	34.1%	3d	Source
H4161 · CA Anthem	Medicare Advantage	n/r	2.2%	85.7%	2d	Source
H0544 · CA Anthem	Medicare Advantage	n/r	1.6%	66.7%	1d	Source
H8432 Anthem	Medicare Advantage	n/r	1.2%	86.9%	3d	Source
NY-Medicaid · NY Anthem	Medicaid	n/r	1.2%	40.2%	1d	Source
H4471 · CA Anthem	Medicare Advantage	n/r	0.9%	94.1%	1d	Source
H6316 · MO Anthem	Medicare Advantage	n/r	0.8%	94.6%	4d	Source

N/R = NOT REPORTED · COLLECTED 2026-07-19 FROM ELEVANCE HEALTH’S PUBLISHED DISCLOSURES

What these numbers mean for your denial

Coverage Rights calculated a 4.5% prior-authorization denial rate for the Medicare Advantage contracts in 2025. In the calculated Medicare Advantage contracts appeal scope, 79.7% were reversed — most denials that got challenged did not survive review. The underlying contract or plan figures were published by Elevance Health; Coverage Rights performed the stated rollup.

The practical takeaway is narrower: an initial denial can change on review. These aggregate rates describe past decisions within the stated reporting scope; they do not predict the result of an individual appeal.

Your appeal deadline depends on your plan type

Elevance Health runs several kinds of plans, and the appeal rules follow the plan, not the insurer. Find the ladder and the deadlines for yours:

Medicare Advantage appeal rights Medicaid appeal rights ACA / Marketplace appeal rights Employer plan (ERISA) appeal rights

Common questions

What is Elevance Health's prior authorization denial rate?

Coverage Rights calculated a 4.5% prior-authorization denial rate for the Medicare Advantage contracts reporting scope in 2025, using the public disclosure required by federal rule CMS-0057-F. Within the calculated Medicare Advantage contracts appeal scope, 79.7% were overturned.

How do I appeal a Elevance Health denial?

Start with the appeal instructions in Elevance Health's denial notice. An independent external, fair-hearing, or Medicare review may be available after the required internal review, but eligibility depends on the coverage program, plan funding, denial type, regulating jurisdiction, and whether the notice says internal review is exhausted. Use the pathway tool before choosing the next reviewer.

Where do these numbers come from?

Coverage Rights calculated the displayed rollup from Elevance Health's public CMS-0057-F disclosures for 2025. The methodology note identifies the included reporting scope and weighting or aggregation method; source links lead to the underlying insurer-published records.

Denied by Elevance Health? 79.7% were overturned in the Coverage Rights rollup of the Medicare Advantage contracts scope. Build an evidence-backed appeal.

How to appeal Start my appeal