Medical Billing & Claim Denial Statistics (2026)

19%

HealthCare.gov insurers denied 19% of in-network claims in 2024, tying 2023 for the highest rate since the ACA marketplaces launched in 2015, with roughly 85 million of about 451 million in-network claims denied.

11.81%

The initial claim denial rate rose to 11.81% in 2024, up 2.4% from 2023, across more than 2,100 hospitals and 300,000 physicians using the Kodiak Revenue Cycle Analytics platform.

~15%

Nearly 15% of all claims submitted to private payers are initially denied, with similar rates for Medicare Advantage (15.7%) and Managed Medicaid (15.1%).

17%

Medicare Advantage plans denied 17% of initial claim submissions, and denials produced a 7% net reduction in provider Medicare Advantage revenue even after appeals.

13.9%

Across private payers, Medicare Advantage claims were initially denied at 15.7% and commercial claims at 13.9%, both at or above the roughly 15% benchmark for initial denials.

60%

60% of medical group leaders reported an increase in their practices' claim denial rates in early 2024 compared to the same period in 2023, based on a March 5, 2024 MGMA poll of 235 leaders, with an average increase of 17% among those seeing denials rise.

55.7%

Between 2022 and 2023, care denials by Medicare Advantage plans surged 55.7%, while commercial payer denials rose an average of 20.2%.

19.7%

The time commercial payers took to process and pay hospital claims from the date of submission increased by 19.7% in 2023, compressing provider revenue cycles even as denials climbed.

7.7%

Medicare Advantage prior authorization denial rates rose from 6.4% in 2023 to 7.7% in 2024, with insurers fully or partially denying 4.1 million of nearly 53 million determinations.

70%

Approximately 70% of denied claims were ultimately overturned and paid in 2023, but only after multiple costly rounds of review.

80.7%

Of the Medicare Advantage prior authorization denials that were appealed in 2024, 80.7% were partially or fully overturned, yet enrollees appealed only 11.5% of denied requests.

54.3%

More than half of denied private payer claims (54.3%) were ultimately overturned, but typically only after providers went through multiple rounds of costly appeals.

13%

An HHS OIG review found that 13% of denied Medicare Advantage prior authorization requests and 18% of denied payment requests actually met Medicare coverage rules and should have been approved.

1 in 8

Medicaid managed care organizations denied 1 in 8 (12.5%) prior authorization requests in 2019, with 12 of 115 plans exceeding a 25% denial rate, more than double the average.

65%

Up to 65% of denied claims are never resubmitted by providers, meaning the revenue is permanently written off even though an estimated 90% of denials are preventable.

$25.7B

Hospitals and health systems spent an estimated $25.7 billion in 2023 contesting claim denials, up 23% from $19.7 billion in 2022, with roughly $18 billion of that potentially wasted on claims that should have been paid at submission.

$57.23

The average administrative cost to rework a denied claim rose from $43.84 in 2022 to $57.23 in 2023, a 30.5% year-over-year increase.

$43B

Hospitals spent $43 billion in 2025 trying to collect payments from insurers for care already delivered, driven by excessive prior authorization, claims denials and delays, and repeated documentation requests.

40%+

Administrative costs now account for more than 40% of total hospital expenses, and hospitals conservatively spend an estimated $40 billion annually on billing and collections alone.

4.8%

Hospitals lose an average of 4.8% of net revenue to denials, representing tens of millions of dollars annually for large health systems.

25%

Of the roughly 85 million in-network ACA claims denied in 2024, 25% were denied for administrative reasons and 9% for lack of prior authorization or referral, categories that electronic and automated workflows directly address.

<1%

Consumers appealed fewer than 1% of denied in-network ACA claims in 2024, and when they did, insurers upheld 66% of those appeals.

39/wk

Physicians complete an average of 39 prior authorization requests per physician per week, and physicians and their staff spend an average of 13 hours each week completing them.

78%

78% of physicians report that prior authorization often or sometimes results in patients abandoning a recommended course of treatment.

$222B

Automation helped the healthcare industry avoid spending $222 billion on administrative tasks in 2024, a 15% increase over the prior year, with a $20 billion savings opportunity still remaining if manual workflows go fully electronic.

31%

Only 31% of medical prior authorization transactions are conducted fully electronically; if all were, spending on prior authorizations would drop by $494 million per year.

$10.97

A manual prior authorization costs providers an average of $10.97 per transaction, nearly double the $5.79 cost of a fully electronic transaction.

40% or less

Most medical group practices have automated 40% or less of their revenue cycle operations, leaving substantial room for denial prevention through electronic workflows.

74%

Claim status inquiry, a key tool for catching pending claims before they are denied, lagged at 74% electronic adoption in 2023, leaving a $3.2 billion annual savings gap.