A rule from the Centers for Medicare & Medicaid Services means Blue Cross Blue Shield of Michigan must share more details about how prior authorization works.
It's a step we sometimes require before you get a medical service. The goal is to make sure that the service is necessary and appropriate.
It helps us make sure you receive the right care, especially in high-risk situations or treatments that can cause serious side effects.
Beyond safety, this process stops fraud, waste and abuse, which helps keep monthly premiums as affordable as possible for everyone.
If you need to know which medical tests and services, excluding drugs, require prior authorization, we have a list of medical services requiring prior authorization.
We're sharing these approval rates to help make everything fair and more clear for you, the member. This information should help you better understand how our prior authorization process works.
This reporting period covers 2025.
This is the most common type of request. Since it's not urgent, it can take up to 14 days for us to make a decision. For a non-urgent appeal, it can take up to 30 days for a decision.
Approved
Reviewed
766,938
Total
800,694
Percentage of total
95.78%
Denied
Reviewed
33,752
Total
800,694
Percentage of total
4.22%
Approved after extended review
Reviewed
4
Total
800,694
Percentage of total
0%
Approved after an appeal
Reviewed
1,929
Total
2,185
Percentage of total
88%
|
|
|
|
|
|---|---|---|---|
|
Approved
|
766,938 | 800,694 | 95.78% |
|
Denied
|
33,752 | 800,694 | 4.22% |
|
Approved after extended review
|
4 | 800,694 | 0% |
|
Approved after an appeal
|
1,929 | 2,185 | 88% |
Your doctor files this type of request when you need a certain service as soon as possible, but it’s not an emergency. It can take up to 72 hours for a decision.
Approved
Reviewed
1,501
Total
1,751
Percentage of total
85.72%
Denied
Reviewed
250
Total
1,751
Percentage of total
14.28%
Approved after extended review
Reviewed
0
Total
1,751
Percentage of total
0%
Approved after an appeal
Reviewed
2,491
Total
2,717
Percentage of total
92%
|
|
|
|
|
|---|---|---|---|
|
Approved
|
1,501 | 1,751 | 85.72% |
|
Denied
|
250 | 1,751 | 14.28% |
|
Approved after extended review
|
0 | 1,751 | 0% |
|
Approved after an appeal
|
2,491 | 2,717 | 92% |
These are the response times that elapsed between the submission of a request and a determination by the payer.
Non-urgent requests (due to provider within 14 days)
Average time
0.72 days
Median time
0 days
Urgent requests (due to provider within 72 hours)
Average time
12.67 hours
Median time
0.94 days
|
|
|
||
|---|---|---|---|
|
Non-urgent requests (due to provider within 14 days)
|
0.72 days | 0 days | |
|
Urgent requests (due to provider within 72 hours)
|
12.67 hours | 0.94 days |
This is the most common type of request. Since it's not urgent, it can take up to 14 days for us to make a decision. For a non-urgent appeal, it can take up to 30 days for a decision.
Approved
Reviewed
167,837
Total
175,680
Percentage of total
95.54%
Denied
Reviewed
7,841
Total
175,680
Percentage of total
4.46%
Approved after extended review
Reviewed
2
Total
175,680
Percentage of total
0%
Approved after an appeal
Reviewed
543
Total
594
Percentage of total
91%
|
|
|
|
|
|---|---|---|---|
|
Approved
|
167,837 | 175,680 | 95.54% |
|
Denied
|
7,841 | 175,680 | 4.46% |
|
Approved after extended review
|
2 | 175,680 | 0% |
|
Approved after an appeal
|
543 | 594 | 91% |
Your doctor files this type of request when you need a certain service as soon as possible, but it’s not an emergency. It can take up to 72 hours for a decision.
Approved
Reviewed
236
Total
278
Percentage of total
84.89%
Denied
Reviewed
42
Total
278
Percentage of total
15.11%
Approved after extended review
Reviewed
0
Total
278
Percentage of total
0%
Approved after an appeal
Reviewed
357
Total
376
Percentage of total
95%
|
|
|
|
|
|---|---|---|---|
|
Approved
|
236 | 278 | 84.89% |
|
Denied
|
42 | 278 | 15.11% |
|
Approved after extended review
|
0 | 278 | 0% |
|
Approved after an appeal
|
357 | 376 | 95% |
These are the response times that elapsed between the submission of a request and a determination by the payer.
Non-urgent requests (due to provider within 14 days)
Average time
0.53 days
Median time
0 days
Urgent requests (due to provider within 72 hours)
Average time
25.8 hours
Median time
1.17 days
|
|
|
||
|---|---|---|---|
|
Non-urgent requests (due to provider within 14 days)
|
0.53 days | 0 days | |
|
Urgent requests (due to provider within 72 hours)
|
25.8 hours | 1.17 days |
This is the most common type of request. Since it's not urgent, it can take up to 15 days for us to make a decision. For a non-urgent appeal, it can take up to 30 days for a decision.
Approved
Reviewed
29.453
Total
31,549
Percentage of total
93.36%
Denied
Reviewed
2,001
Total
31,549
Percentage of total
6.34%
Approved after extended review
Reviewed
95
Total
31,549
Percentage of total
0.30%
Approved after an appeal
Reviewed
5
Total
24
Percentage of total
21%
|
|
|
|
|
|---|---|---|---|
|
Approved
|
29.453 | 31,549 | 93.36% |
|
Denied
|
2,001 | 31,549 | 6.34% |
|
Approved after extended review
|
95 | 31,549 | 0.30% |
|
Approved after an appeal
|
5 | 24 | 21% |
Your doctor files this type of request when you need a certain service as soon as possible, but it’s not an emergency. It can take up to 72 hours for a decision.
Approved
Reviewed
964
Total
1,008
Percentage of total
95.63%
Denied
Reviewed
44
Total
1,008
Percentage of total
4.37%
Approved after extended review
Reviewed
0
Total
1,008
Percentage of total
0%
Approved after an appeal
Reviewed
14
Total
23
Percentage of total
61%
|
|
|
|
|
|---|---|---|---|
|
Approved
|
964 | 1,008 | 95.63% |
|
Denied
|
44 | 1,008 | 4.37% |
|
Approved after extended review
|
0 | 1,008 | 0% |
|
Approved after an appeal
|
14 | 23 | 61% |
These are the response times that elapsed between the submission of a request and a determination by the payer.
Non-urgent requests (due to provider within 15 days)
Average time
0.61 days
Median time
0 days
Urgent requests (due to provider within 72 hours)
Average time
9.58 hours
Median time
0 days
|
|
|
||
|---|---|---|---|
|
Non-urgent requests (due to provider within 15 days)
|
0.61 days | 0 days | |
|
Urgent requests (due to provider within 72 hours)
|
9.58 hours | 0 days |
This is the most common type of request. Since it's not urgent, it can take up to 15 days for us to make a decision. For a non-urgent appeal, it can take up to 30 days for a decision.
Approved
Reviewed
49,654
Total
53,252
Percentage of total
93.24%
Denied
Reviewed
3,501
Total
53,252
Percentage of total
6.57%
Approved after extended review
Reviewed
97
Total
53,252
Percentage of total
0.18%
Approved after an appeal
Reviewed
32
Total
50
Percentage of total
64%
|
|
|
|
|
|---|---|---|---|
|
Approved
|
49,654 | 53,252 | 93.24% |
|
Denied
|
3,501 | 53,252 | 6.57% |
|
Approved after extended review
|
97 | 53,252 | 0.18% |
|
Approved after an appeal
|
32 | 50 | 64% |
Your doctor files this type of request when you need a certain service as soon as possible, but it’s not an emergency. It can take up to 72 hours for a decision.
Approved
Reviewed
1,025
Total
1,079
Percentage of total
95.00%
Denied
Reviewed
54
Total
1,079
Percentage of total
5.00%
Approved after extended review
Reviewed
0
Total
1,079
Percentage of total
0%
Approved after an appeal
Reviewed
12
Total
14
Percentage of total
86%
|
|
|
|
|
|---|---|---|---|
|
Approved
|
1,025 | 1,079 | 95.00% |
|
Denied
|
54 | 1,079 | 5.00% |
|
Approved after extended review
|
0 | 1,079 | 0% |
|
Approved after an appeal
|
12 | 14 | 86% |
These are the response times that elapsed between the submission of a request and a determination by the payer.
Non-urgent requests (due to provider within 15 days)
Average time
0.58 days
Median time
0 days
Urgent requests (due to provider within 72 hours)
Average time
7.36 hours
Median time
0 days
|
|
|
||
|---|---|---|---|
|
Non-urgent requests (due to provider within 15 days)
|
0.58 days | 0 days | |
|
Urgent requests (due to provider within 72 hours)
|
7.36 hours | 0 days |
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Other issues: For customer service, call the number on the back of your member ID card.
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