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Blue Cross Blue Shield of Michigan: Medicare Advantage denial & appeal rates
Blue Cross Blue Shield of Michigan Mutual Insurance Co. · 1.9% of MA enrollment
2025 prior-authorization metrics, as posted by Blue Cross Blue Shield of Michigan
Combined from the counts Blue Cross Blue Shield of Michigan publishes for its two Medicare Advantage products: Medicare Plus Blue PPO (33,752 of 800,694 standard requests denied) and BCN Advantage (7,841 of 175,680). Its commercial and ACA plans are reported on the same page and are excluded here.
These numbers aren’t comparable to the six largest insurers’ pages.
Medicare’s published comparison of insurers only names parent companies with a million or more Medicare Advantage members, so Blue Cross Blue Shield of Michigan isn’t in it. The figures above are Blue Cross Blue Shield of Michigan’s own 2025 filing, which covers a different year and counts denials a different way. Treat them as what this insurer reports about itself — not as a like-for-like ranking against the larger insurers.
Whatever the rate, the pattern that matters is the same everywhere: ~81% of appealed MA prior-authorization denials are overturned, and only about 1 in 9 denials is ever appealed. A denial is rarely the final word — and Blue Cross Blue Shield of Michigan’s own filing shows most of the denials its members appealed were approved in the end.
Blue Cross Blue Shield of Michigan’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.
Blue Cross Blue Shield of Michigan’s CMS prior-authorization metrics posting →
Denied by Blue Cross Blue Shield of Michigan? 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 calendar-year 2025 prior-authorization metrics posted by Blue Cross Blue Shield of Michigan under the CMS Interoperability and Prior Authorization rule (CMS-0057-F). "Approved after appeal" is the share of appealed denials that were later approved — not a share of all denials. Data as of September 2026. Notes: Reports by product rather than by Medicare contract. Also the parent of Blue Care Network, Wellmark Advantage, NextBlue of North Dakota and WyoBlue. Informational only — not medical, legal, or billing advice.