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HCSC / HealthSpring: Medicare Advantage denial & appeal rates
Health Care Service Corporation · 2.5% of MA enrollment
2025 prior-authorization metrics, as posted by HCSC / HealthSpring
15 Medicare Advantage contracts. Average decision time 0.80 days.
11 Medicare Advantage contracts. Average decision time 1.66 days.
HCSC posts two separate reports and they disagree sharply — 5% of standard requests denied on the HealthSpring side against 12% on the Blue-branded side. Neither report publishes the number of requests behind its percentages, so there is no honest way to combine them into one HCSC figure. Which number applies to you depends on which plan you are actually in: check the brand on your card.
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 HCSC / HealthSpring isn’t in it. The figures above are HCSC / HealthSpring’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 HCSC / HealthSpring’s own filing shows most of the denials its members appealed were approved in the end.
HCSC / HealthSpring’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.
HCSC / HealthSpring’s CMS prior-authorization metrics posting →
Denied by HCSC / HealthSpring? 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 HCSC / HealthSpring 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: Holds the Medicare Advantage book Cigna sold to HCSC (sale closed March 19, 2025). Cigna no longer offers Medicare Advantage; for the 2026 plan year these plans are branded HealthSpring, except in Illinois, Montana, New Mexico, Oklahoma and Texas where they run under Blue Cross and Blue Shield. Informational only — not medical, legal, or billing advice.