Health Care Service Corporation — Denial Rates & Appeal Data
Compare against every insurer we track: denial rates ranked within reporting cohorts.
PUBLISHER-REPORTED FIGURES · HEALTH CARE SERVICE CORPORATION PUBLIC DISCLOSURE
HCSC's posted Medicare Advantage rollup across its Blue plans in IL, MT, NM, OK, and TX (11 contracts) — standard requests; urgent-request denial rate was 21%. Request volumes not published. Marketplace metrics posted separately per state.
SOURCE: HEALTH CARE SERVICE CORPORATION CMS-0057-F DISCLOSURE, CY2025 · VIEW SOURCE ↗ · METHODOLOGY
What these numbers mean for your denial
Health Care Service Corporation reported a 12% prior-authorization denial rate for the Medicare Advantage Blue plans in 2025. In the publisher-reported Medicare Advantage Blue plans appeal scope, 80% were reversed — most denials that got challenged did not survive review. Health Care Service Corporation published the displayed denial and appeal rates in its CMS-0057-F disclosure; decision-time cards identify any Coverage Rights unit conversions.
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
Health Care Service Corporation runs several kinds of plans, and the appeal rules follow the plan, not the insurer. Find the ladder and the deadlines for yours:
Common questions
What is Health Care Service Corporation's prior authorization denial rate?
Health Care Service Corporation reported a 12% prior-authorization denial rate for the Medicare Advantage Blue plans reporting scope in 2025, using the public disclosure required by federal rule CMS-0057-F. Within the publisher-reported Medicare Advantage Blue plans appeal scope, 80% were overturned.
How do I appeal a Health Care Service Corporation denial?
Start with the appeal instructions in Health Care Service Corporation'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?
Health Care Service Corporation published the underlying figures in its CMS-0057-F disclosure for 2025; the methodology note identifies the exact reporting scope and any Coverage Rights unit conversions, and the page links to the source.