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Kaiser Permanente: Medicare Advantage denial & appeal rates
Kaiser Foundation Health Plan · 6% of MA enrollment
In 2024, Kaiser Permanente denied about 10.3% of the prior-authorization requests it reviewed. When members appealed, 50.2% of those denials were overturned — yet only 1.7% of denials were appealed at all. ~81% of appealed MA prior-authorization denials are overturned, so a denial is rarely the final word.
Kaiser Permanente’s posted coverage policies
Insurers must post the medical policies they use to decide coverage. These are the ones most relevant to lab, imaging, and facility denials — quote the matching policy in your appeal.
| Service category | Policy | Updated |
|---|---|---|
| ALL 20 categories | not located (no national public MA medical-policy library) | — |
Kaiser Permanente’s CMS prior-authorization metrics posting →
Denied by Kaiser Permanente? Don’t pay a bill you may not owe.
Appeals win far more often than people expect. See how the deadlines and the process work, or fast-track a rehab/nursing discharge.
Insurer / contract level. Medicare does not publish per-plan denial rates. Rates are 2024 prior-authorization determinations; data as of July 2026. Notes: Denial 10.3% & appeal 1.7% now filled from KFF chart dataset (were blank in prose). Lowest appeal share & lowest overturn (50.2%; prose 51.0%). Posting = 9 regional PDFs+XML, contract-ID level, CY2025 (report date 3/27/2026); verbatim SoCal… Informational only — not medical, legal, or billing advice.