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Find the claim value below which an appeal costs more than it brings back, on average. The cost to work a denial starts at Premier's 2023 average, and you can swap in your own.
Enter one claim. You'll see its expected net, the break-even claim value, and the overturn rate this claim would need to pay back.
Free, with no form to see your result. Your numbers stay in your browser unless you email yourself the result.
$286.15Break-even claim value at these rates
Worked example below: 50% overturn rate, 40% of billed charges paid.
Find the claim value below which an appeal costs more than it brings back, on average. The cost starts at Premier's average for 2023 claims, and you can replace it with your own. Nothing you type leaves your browser unless you choose to send it.
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Your result
Fill in your numbers, or use the example, and your result appears here.
At Premier's 2023 averages, where 68.6% of denied claims were ultimately paid, break-even is $57.23 ÷ 0.686 = $83.43 of payment per overturned claim (TSI calculation).
Claim value is billed charges. Share collected is what an overturned claim pays, as a share of those charges.
| Input or result | Value |
|---|---|
| What goes in | |
| Cost to work one denial | $57.23 |
| Overturn rate | 50% |
| Share of billed charges collected | 40% |
| Claim value | $250 |
| What comes out | |
| Payment if overturned | $100.00 |
| Expected cash | $50.00 |
| Expected net | -$7.23 |
| Break-even claim value | $286.15 |
| Break-even payment | $114.46 |
| Overturn rate needed | 57.2% |
At these rates, appealing a $250 claim loses $7.23 on average. Claims above $286.15 pay back their appeal cost.
At Premier's 2023 averages, where 68.6% of denied claims were ultimately paid, break-even is $57.23 ÷ 0.686 = $83.43 of payment per overturned claim (TSI calculation).
Press “Fill in the example” in the calculator above to load these numbers and check them.
Rows are overturn rates; columns are the cost to work one denial. The calculator adds a column for your own cost and uses your share collected.
| Overturn rate | $25.00 | $43.84 | $57.23 | $75.00 | $100.00 |
|---|---|---|---|---|---|
| 20% | $312.50 | $548.00 | $715.38 | $937.50 | $1,250.00 |
| 30% | $208.33 | $365.33 | $476.92 | $625.00 | $833.33 |
| 40% | $156.25 | $274.00 | $357.69 | $468.75 | $625.00 |
| 50% | $125.00 | $219.20 | $286.15 | $375.00 | $500.00 |
| 60% | $104.17 | $182.67 | $238.46 | $312.50 | $416.67 |
| 70% | $89.29 | $156.57 | $204.39 | $267.86 | $357.14 |
| 80% | $78.13 | $137.00 | $178.84 | $234.38 | $312.50 |
$57.23
Average cost to work one contested denial, 2023 claims
Source: Premier, average cost per contested denial for 2023 claims (vendor-published member survey, February 2025)
68.6%
Share of denied claims ultimately paid, 2023 claims
Source: Premier, same member survey (February 2025)
The billed charges at which an appeal's expected cash equals the cost to work it. Above it, appeals pay back on average; below it, they cost more than they return.
An overturned claim rarely pays full billed charges. At 40% collected, a $250 claim pays $100 when it's overturned, so break-even climbs to $286.15 at a 50% overturn rate.
It's Premier's average cost per contested denial for 2023 claims, from a member survey Premier published in February 2025. Replace it with your own cost if you track it.
When you're deciding on a whole class of denials. The by-band calculator splits one payer's denials into claim-value bands and adds up the yearly net for each.
The Denials Economics Sprint works one payer and one denial class and measures overturn, paid yield and cost per claim against your own baseline, so your break-even comes from real results.
Request a Denials Economics Sprint
The Denials Economics Sprint is free and carries no obligation. Any work after it is scoped and priced separately, and only if you choose to go ahead.
Which claim-value bands of one payer and denial class pay back the cost of an appeal.
Denials, appeals, early-out and patient balances for hospitals and health systems.
Agency net-back, sell or place, denial economics and appeal break-even.
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