When physicians and patients challenge prior-authorization denials, insurers frequently change their answer.

Newly public, insurer-reported 2025 data analyzed by KFF show that 67% of appealed standard prior-authorization denials were overturned in Medicare Advantage. Insurers also reversed 47% of appealed denials in Medicaid managed care, and 43% in federally facilitated Affordable Care Act Marketplace plans.

The figures do not prove that those original denials were inappropriate. Some approvals may have followed the submission of documentation missing from the initial request. But the results add new evidence to a longstanding physician complaint: prior authorization consumes substantial practice resources while sometimes delaying care that insurers ultimately approve.

The same reporting shows that insurers denied an average of 12% of standard prior-authorization requests in Medicare Advantage, 14% in Medicaid managed care and 18% in federally facilitated Marketplace plans.

Those averages mask substantial differences among insurers. Among the major companies KFF evaluated, Medicare Advantage denial rates ranged from 5% to 17%. The range was 2% to 23% in Medicaid managed care and approximately 3% to 25% in the federally facilitated Marketplace.

For physicians, that means prior-authorization experience can depend heavily on which insurer covers the patient.

The bigger question now is what should happen next.

The federal government is largely pursuing automation. Beginning in 2027, affected payers must implement electronic prior-authorization capabilities that can identify documentation requirements, accept requests, and return approvals, specific denial reasons, or requests for additional information.

California lawmakers are pursuing a different strategy: reducing repetitive authorization. AB 539, sent to Gov. Gavin Newsom in early September, would generally require an approved authorization requested by an in-network provider to remain valid for at least one year, or for a shorter treatment period the physician requests. The measure had not been verified as signed as of Sept. 7.

Sidecar Health CEO Patrick Quigley wants to go much further.

In an interview with Becker’s Hospital Review, Quigley called for making prior authorization illegal. Sidecar’s non-network model differs substantially from traditional managed-care insurance. It pays predetermined local Benefit Amounts, lets members use any provider, and uses price transparency and member financial incentives rather than prior authorization to influence utilization and cost.

That makes Sidecar a useful real-world example of an insurer operating without traditional prior authorization. It does not prove that the same model can simply replace utilization management in Medicare Advantage, Medicaid managed care or conventional commercial insurance.

Still, the debate is moving beyond how to make prior authorization faster.

Washington is trying to automate it. California is trying to reduce how often physicians must repeat it. And some critics now argue that the better solution is to eliminate it.

For physicians, the newly available data may also have an immediate practical use.

Medical groups can track prior-authorization requests by payer, initial denial rates, reasons for denial, appeal rates, reversal rates, treatment delays and staff time. Those internal results can then be compared with insurer-reported performance.

That could help practices identify where administrative burden is greatest — and where an initial denial may be especially worth challenging.

The new reporting does not answer every question. It does not show which procedures or specialties generate the most denials, whether overturned denials were originally inappropriate, or how much medically recommended care is delayed or abandoned after an initial denial. Comparable public reporting also remains limited for much of the self-funded employer insurance market.

But physicians now have something often missing from the prior-authorization debate: measurable evidence showing how often insurers say no—and how often that answer later becomes yes.

The new federal data do not identify which services or specialties generate the most denials, whether overturned denials were originally inappropriate, or how often recommended care is delayed or abandoned because of prior authorization. They also do not provide a comparable national picture of much of the self-funded employer insurance market.