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Anthem (Elevance Health): Medicare Advantage denial & appeal rates
Elevance Health / Anthem · 5% of MA enrollment
In 2024, Anthem (Elevance Health) denied about 4.1% of the prior-authorization requests it reviewed. When members appealed, 87.9% of those denials were overturned — yet only 9.1% of denials were appealed at all. ~81% of appealed MA prior-authorization denials are overturned, so a denial is rarely the final word.
Anthem (Elevance Health)’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.
Anthem (Elevance Health)’s CMS prior-authorization metrics posting →
Denied by Anthem (Elevance Health)? 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: Lowest denial rate. KFF prose/chart-title cite 4.2% (vs 4.1% chart dataset) - flagged. Anthem CMS-0057-F posting CONFIRMED: per-MA-contract PDFs at the DAM pattern shown (verified H1607 CY2025 = 4.2% std denial; see contract-samples sheet).… Informational only — not medical, legal, or billing advice.