The 65% Problem: Why Most Denials Are Never Appealed (And How Math Fixes It)
Manoj Varghese(Head of RCM Operations)
July 2026 6 min read
“According to HFMA, roughly 65% of denied medical claims are never appealed. That is not negligence — it is simple arithmetic. Here is how automation flips the equation.”
When it costs $57.23 in staff wages and overhead to rework the average denied claim (Premier Inc. 2023), billing teams make a rational economic choice: abandon any claim under $150.
Over the course of a year, that single heuristic bleeds between 3% and 7% of net practice collections directly into payer balance sheets.
By using modern automated remittance parsing and generative clinical appeal workflows, the cost to work a denial drops from $57 to under $9. When rework cost falls below $10, every single denied claim becomes a profitable recovery opportunity.