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As of October 2026, hospital initial denial rates run from 11.81% (Kodiak Solutions, 2024 data) to nearly 15% (Premier, 2023 claims). HealthCare.gov insurers denied 19% of in-network claims in 2024 (KFF). Premier puts the cost of fighting a denial at $57.23 per claim, and Medicare Advantage insurers denied 7.7% of prior authorization requests in 2024.
TSI (Transworld Systems Inc.) publishes it. TSI provides Accounts Receivable Management (ARM), Healthcare Revenue Cycle Management (RCM), CXBPO and Loan Servicing (via UAS). DebtNext, a TSI company, makes recovery management software for creditors. Some options this page describes compete with services TSI sells. Each figure names its publisher and date so you can check it yourself.
Every figure below was checked on the publisher's own page on October 13, 2026. Several come from vendors' own research, and the card says so. Read "How to read these numbers" before you put 2 of them side by side.
There's no single national denial rate. Each publisher measures a different set of claims, so the honest answer is a range.
Initial denial rate on claims in 2024, up 2.4% from 2023, across the 2,100+ hospitals and 300,000 physicians on Kodiak's platform. It's vendor research from Kodiak's platform data.
Average initial denial rate in Premier's survey of 280 hospitals for 2023 claims, across all payer types, with some as high as 49%. Premier is a group purchasing organization that advocates on payer policy.
Share of in-network claims that HealthCare.gov marketplace insurers denied in 2024 (37% out of network, 20% overall). It's insurer-reported, covers HealthCare.gov plans only, and leaves out claims that were resubmitted and paid.
Share of providers reporting denial rates of 10% or higher in Experian Health's 2025 survey of 250 revenue cycle professionals, up every year since 2022. It's a share of providers, not an average rate.
MGMA's single-specialty aggregate rate for claims denied on first submission (2023 data set). In a March 2024 MGMA Stat poll, 60% of medical group leaders said their denial rates had gone up.
Medicare Advantage plans' initial and final denial rates were more than double traditional Medicare's in 2025, on Kodiak's platform data.
For what counts as a good rate for your own organization, see what a good claim denial rate looks like.
Providers point first to data and registration problems. Insurers often don't name a reason at all.
Share of providers in Experian Health's 2025 survey who named missing or inaccurate data as a top denial cause, up from 46%. Authorizations came in at 35% and registration data at 32%.
Share of in-network marketplace denials in 2024 where the insurer gave "other" as the reason. Administrative reasons were 25%, missing prior authorization or referral 9% and lack of medical necessity 5%.
Share of claim denials reworked with at least some human review before resubmission, in Experian Health's 2025 survey.
Fighting a denial costs staff time on every claim, whether it pays or not. These are the published estimates of that bill.
Average administrative cost per denied claim that hospitals fought in 2023, across all payers, up from $43.84 in 2022. From Premier's provider survey, published February 2025.
Share of contested denied claims that were ultimately paid in Premier's 2023 survey data, which Premier rounds to about 70%.
Premier's estimate of what providers spent adjudicating claims in 2023, up 23%, of which about $18 billion went to claims that were eventually paid. It's modeled from the survey averages.
The American Hospital Association's estimate of what hospitals spent in 2025 trying to collect payments insurers owe, including nearly $18 billion on overturning denials. It's from an AHA advocacy report.
Net revenue the 2,300+ hospitals on Kodiak's platform lost to final denials and bad debt in 2025, up 25% from $38.6 billion. The median final denial rate rose from 2.5% to 2.7%.
Share of medical practice leaders who named denials and appeals as their biggest revenue cycle leak in a January 2026 MGMA Stat poll (288 responses).
Kodiak says clinical denials, including prior authorization and medical necessity, accounted for virtually all of the 2025 rise in revenue its hospitals lost to final denials and bad debt.
Share of 52.8 million prior authorization requests that Medicare Advantage insurers fully or partially denied in 2024: about 4.1 million denials, up from 6.4% in 2023.
Share of Medicare Advantage prior authorization denials that were appealed in 2024. Of those appeals, 80.7% were partly or fully overturned.
Share of denied claims in Premier's 2023 survey data that had already been approved through prior authorization, up from 3.2% in 2022. In Medicare Advantage, 30.5% of claims required prior authorization in 2023.
Share of Medicare Advantage prior authorization denials in an HHS OIG sample that met Medicare coverage rules, so they'd likely have been approved under original Medicare. For payment denials it was 18%. The sample is from 2019.
Appeal windows differ by payer, and a missed one closes the claim. How long you have to appeal a denied claim lists the common limits.
When a denial stands or a deductible applies, the balance moves to the patient, and in 2025 patients paid less of it than the year before.
Share of what they owed that insured patients paid in 2025, down from 45.1% in 2024. Patients were responsible for 7.3% of their bills, up from 6.8%.
Rise in hospital bad debt in 2025, which the American Hospital Association links to administrative friction that delays payment.
Median bad debt rate on Kodiak's platform in 2025, up from 1.1% in 2024.
Average deductible for workers with single coverage and a general annual deductible in 2025, up 43% over 10 years. KFF's 2026 survey is due soon and will replace it.
Share of denied in-network marketplace claims that consumers appealed in 2024. Insurers upheld 66% of those appeals. These are patient appeals, not provider appeals.
What happens to those balances next is covered on the early-out self-pay page.
Three provisions of Public Law 119-21 (the One Big Beautiful Bill Act) take effect on January 1, 2027, 11 weeks from this update. Each one changes who's covered when a patient arrives, and so what lands in self-pay.
Deadline for states to start Medicaid work requirements for expansion adults ages 19 to 64, with exemptions. States can start earlier, and HHS good-faith exemptions can run to December 31, 2028.
Monthly work, community service or work program hours the requirement calls for, or half-time enrollment in school.
Retroactive Medicaid coverage for expansion adults applying from January 1, 2027, down from 3 months. Other enrollees get 2 months.
How often states must redetermine eligibility for expansion adults, for redeterminations scheduled from January 1, 2027.
People disenrolled during the 2023-2024 Medicaid unwinding, 69% of them for paperwork or procedural reasons. Enrollment fell another 5.1 million (6%) from June 2025 to June 2026.
Initial and final denial rates measure different things. An initial denial is the payer's first answer; a final denial is what's left after rework and appeals. Kodiak's 11.81% initial rate and its 2.7% median final rate describe the same hospitals at 2 different points.
KFF's 19% comes from insurers, covers HealthCare.gov plans only, and drops claims that were resubmitted and paid. Provider-side initial rates count those claims, so the 2 aren't comparable.
Premier's $57.23 is an all-payer average for 2023 data from a survey of its member hospitals, weighted by bed count. Its $25.7 billion is a model built on those averages. The AHA's $43 billion is an estimate in an advocacy report.
Kodiak's figures are platform data from the hospitals that use its software. Experian Health's and MGMA's are self-reported surveys and polls. Both kinds are useful; neither is a census.
KFF's Medicare Advantage figures count prior authorization requests, which happen before care. They aren't claim denials.
These show up in articles, vendor decks and RFP responses. Here's what the sources support.
We couldn't trace either number to the association it's usually credited to. The $25 traces back to a 2019 trade article, and the $118 was an appeal cost from a 2017 article. Premier's $57.23 per denied claim fought (2023 data) is the current published figure.
Premier's $57.23 covers all payer types. It isn't a private-payer figure.
We found no primary source. What the data does show: only 11.5% of Medicare Advantage prior authorization denials were appealed in 2024, and 80.7% of those appeals won (KFF).
Neither appears in a source we could find. Premier's survey found 68.6% of contested denials were ultimately paid.
It's repeated widely without a primary page and appears to trace to a 2017 estimate. For current scale, use Premier's $25.7 billion adjudication cost or Kodiak's $48 billion+ in net revenue lost.
It's real, and it's Kodiak Solutions' figure for 2024 (11.81%). It's often credited to other publishers.
Several figures here will be replaced soon. We'll update this page as they publish.
Published initial denial rates run from 11.81% (Kodiak Solutions, 2024 data from 2,100+ hospitals) to nearly 15% (Premier, 2023 claims). KFF found HealthCare.gov insurers denied 19% of in-network claims in 2024, but that figure leaves out claims resubmitted and paid, so it isn't directly comparable.
Premier's February 2025 survey put the average administrative cost at $57.23 per denied claim fought in 2023, across all payers, up from $43.84 in 2022. Your own cost depends on the denial type and how many rounds it takes.
In Premier's 2023 data, 68.6% of contested denials were ultimately paid. KFF found 80.7% of Medicare Advantage prior authorization appeals were partly or fully overturned in 2024, though only 11.5% of denials were appealed.
Medicare Advantage insurers fully or partially denied 4.1 million of 52.8 million prior authorization requests in 2024, or 7.7% (KFF, January 2026).
It depends on your volumes, your denial mix and your in-house capacity. Should a hospital outsource denial management? weighs the trade-offs, and the denial management page describes how TSI works denied claims.
General information, current as of Nov 5, 2026. It isn't legal advice. Rules change and differ by state, so check the sources linked here and talk to your own counsel before you act on it.
The Denials Economics Sprint takes one payer and one denial class against a defined baseline, and reports overturn, paid yield, cost per claim and the claim value below which an appeal stops paying back.
Research