Kaiser Permanente — Denial Rates & Appeal Data
Compare against every insurer we track: denial rates ranked within reporting cohorts.
COVERAGE RIGHTS ROLLUP · CALCULATED FROM KAISER PERMANENTE PUBLIC DISCLOSURES
Rollup computed from Kaiser Permanente's posted regional CMS-0057-F reports (10 Medicare Advantage contracts across 8 regions plus 5 state Medicaid programs). Rates vary widely by region — the Southern California MA contract reported a 19.5% standard denial rate. Decision times are published per contract only.
UNDERLYING SOURCE: KAISER PERMANENTE CMS-0057-F DISCLOSURE, CY2025 · VIEW SOURCE ↗ · METHODOLOGY
What these numbers mean for your denial
Coverage Rights calculated a 9.1% prior-authorization denial rate for the Medicare Advantage and Medicaid reporting units in 2025. In the calculated Medicare Advantage and Medicaid reporting units appeal scope, 44.3% were reversed — a substantial share of challenged denials did not survive review. The underlying contract or plan figures were published by Kaiser Permanente; 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
Kaiser Permanente 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 Kaiser Permanente's prior authorization denial rate?
Coverage Rights calculated a 9.1% prior-authorization denial rate for the Medicare Advantage and Medicaid reporting units reporting scope in 2025, using the public disclosure required by federal rule CMS-0057-F. Within the calculated Medicare Advantage and Medicaid reporting units appeal scope, 44.3% were overturned.
How do I appeal a Kaiser Permanente denial?
Start with the appeal instructions in Kaiser Permanente'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 Kaiser Permanente'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.