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Some denials cost more to appeal than they'll ever pay back. Pick one payer and one denial class, split its denials into claim-value bands, and see which bands earn their appeal cost.
You'll get the yearly net for each band, the break-even claim value, and what working only the paying bands would be worth.
Free, with no form to see your result. Your numbers stay in your browser unless you email yourself the result.
$309,613A year from the 3 bands that pay back
Worked example below: one payer, one denial class, 2,360 denials a year.
Pick one payer and one denial class, then split its denials into claim-value bands. See which bands pay back the cost of an appeal and which don't. Nothing you type leaves your browser unless you choose to send it.
Check these numbers
Your result
Fill in your numbers, or use the example, and your result appears here.
Overturn rate counts claims. Paid yield counts dollars, on the claims that were overturned. Each is applied once, so expected cash per appeal is claim value × overturn rate × paid yield, less any vendor share.
These are averages. A band below break-even can still hold individual claims worth working.
Overturn rate counts claims. Paid yield counts dollars on the claims that were overturned. Each is applied once, so the overturn rate is never counted twice.
| Under $250 | $250 to $1,000 | $1,000 to $5,000 | Over $5,000 | |
|---|---|---|---|---|
| What goes in | ||||
| Denials a year | 1,200 | 800 | 300 | 60 |
| Average claim value | $150 | $550 | $2,400 | $9,000 |
| Overturn rate | 45% | 50% | 55% | 60% |
| What comes out | ||||
| Expected cash per appeal | $27.00 | $110.00 | $528.00 | $2,160.00 |
| Net per appeal | -$30.23 | $52.77 | $470.77 | $2,102.77 |
| Net a year | -$36,276 | $42,216 | $141,231 | $126,166 |
| Break-even claim value | $317.94 | $286.15 | $260.14 | $238.46 |
| Worth working? | No | Yes | Yes | Yes |
Working all 4 bands nets $273,337 a year. Working the 3 bands above $250 nets $309,613, because the under-$250 band loses $36,276.
These are averages. A band below break-even can still hold individual claims worth working.
Press “Fill in the example” in the calculator above to load these numbers and check them.
$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)
Overturn rate is the share of appealed claims that get overturned, counted by claims. Paid yield is the cash you collect on those overturned claims, as a share of billed charges. The calculator multiplies them once, so neither is double-counted.
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, including any per-claim vendor fee.
Not on the average alone. A band below break-even can still hold claims worth working, so sort that band's claims by value, or test it on a sample before you drop it.
One with enough volume to measure and claim values high enough for the economics to matter. That's the same cohort a Denials Economics Sprint starts from.
No. The math runs in your browser, and nothing is sent unless you fill in the email form under your result and press send.
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.
The claim value below which one appeal costs more than it brings back.
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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