Ohio insurers now publish their own prior-auth denial numbers. We read them.

A federal rule (CMS-0057-F) makes Medicare Advantage, Medicaid managed care, and marketplace insurers publicly report their prior-authorization numbers every year: how many requests they denied, and how often those denials were overturned when someone appealed. The first reports, covering 2025, are out. Here is what Ohio's insurers reported about themselves.

Check my denial, free See the numbers

Every number below is the plan's own published figure, linked to its source.

Ambetter / Buckeye (Marketplace)

28.4% denied

Of 52,991 standard prior-auth requests in 2025. When members appealed, the plan reversed itself 56.9% of the time (251 of 441 appeals). Source: the plan's published report.

CareSource (Marketplace)

28% denied

Of 42,446 standard requests. 31% of appealed denials were overturned (143 appeals). Source: the plan's published report.

Medical Mutual of Ohio

8% denied (Marketplace)

89% of appealed denials overturned, though on a small sample (16 of 18). Their Medicare Advantage line: 6% denied, 56% of appeals overturned (182 of 325).

Read the two numbers together

Buckeye denied more than one in four prior-auth requests, and when members pushed back, the plan reversed itself more than half the time. Those are Buckeye's own published numbers, not ours. A denial that gets overturned on appeal was, by the plan's own later judgment, a denial that should not have stood.

Now the number that is not in any report: fewer than 1% of denied claims are ever appealed (KFF analysis of 2023 federal marketplace data). The overturn rates above describe the tiny fraction of people who fought. Almost everyone else just gave up. These are plan-level statistics about each insurer's own reported outcomes, not a prediction for any individual case, and not an Appealit outcome claim.

What is missing is also worth knowing. We could not find the required report for CareSource's Ohio Medicaid line, the largest Medicaid plan in the state, or for Anthem/Elevance's Ohio plans (as of July 2026). Our search is not proof of noncompliance, and we will link those reports if they surface. But a transparency rule only works if the reports exist and someone reads them.

What this means if your prior auth was denied in Ohio

Your denial letter has an appeal deadline on it, often 60 to 180 days from the denial date, and the letter controls. Appealit reads your denial, checks your plan's own published coverage rules, and drafts your appeal with every citation verified before you see it. Free, always. You review, sign, and file it yourself.

Denied in Ohio? See what your denial actually says.

Upload the letter. We will tell you honestly what kind of denial it is and draft the appeal for free.

Check my denial, free

Sourced from each plan's published CMS-0057 prior-authorization metrics report (linked above), CY2025 data, standard (non-expedited) requests. Reports are payer-self-reported and unaudited; methodologies vary by plan; small appeal samples are noted where reported. Appeal-overturn rates describe each plan's own reported outcomes for appealed denials. Appealit is not a law firm and does not provide legal or medical advice. Results vary by case and are not guaranteed.