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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. about 8 in 10 appealed Medicare Advantage prior-authorization denials are overturned, fully or in part (KFF, 2024 data), so a denial is rarely the final word.
One number for several regions.
Company-wide average across Kaiser's nine regional Medicare Advantage contracts, which run as near-separate health systems. A member in one region may see a very different rate from this average. Kaiser's own posting breaks out each region for 2025. See Kaiser Permanente’s regional posting.
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.
Most denials are never appealed; the published figures for those that are are on the scorecard. 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 (KFF analysis of CMS contract-level data). Data as of September 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.