Insurance Denial Statistics: The Numbers You Need to Know
Insurance claim denials affect millions of Americans every year. Understanding the scale of the problem — and how often appeals succeed — can help you decide whether to fight your denial.
Key Statistics at a Glance
Note on scope: Many widely cited denial and appeal figures come from ACA Marketplace reporting (HealthCare.gov) and may not reflect employer-sponsored, Medicare, Medicaid, or other plan types. Use these numbers as directional context, not guarantees.
Why Don't More People Appeal?
Despite potentially meaningful success rates in some datasets, very few denied claims are appealed. The most common reasons:
- People don't know they can — Many patients assume a denial is final
- The process is confusing — Appeal procedures vary by insurer and state
- Writing an appeal letter is hard — Most people don't know what to say or cite
- Time pressure — People dealing with health issues have limited energy for paperwork
- Small claim amounts — Some denials seem "not worth the effort" (though they add up)
Most Commonly Denied Procedures
While denial rates vary by insurer and plan, certain categories face higher denial rates:
- Mental health and substance abuse treatment — Often denied as "not medically necessary"
- Physical therapy and rehabilitation — Frequently denied after a set number of sessions
- Advanced imaging (MRI, CT scans) — Often requires prior authorization
- Specialty medications — Especially biologics and brand-name drugs
- Surgical procedures — Particularly elective or reconstructive surgery
- Emergency room visits — Retroactively denied as "not a true emergency"
The Cost of Not Appealing
When patients don't appeal, they either:
- Pay out of pocket for treatment they should have been covered for
- Skip necessary medical care entirely
- Accumulate medical debt
Appeal success rates can be meaningful, but they vary a lot by plan type and denial category. If you don't appeal, you may be leaving money — and potentially your health — on the table.
Make Your Appeal Count
The biggest barrier to appealing is the difficulty of writing a strong appeal letter. MedAppeals removes that barrier by using AI to draft professional appeal letters in seconds.