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Imagine this: You see a patient, perform the exam, document the care, your staff submits the claim—to all appearances everything looks right. But then the claim comes back denied. The team may shrug, file it away, mark it unresolved. And the revenue disappears. What you delivered—the service, the documentation, the provider expertise—is lost financially. And more often than you think, this is happening silently. And this is in addition to the money you’re losing on adjustments, which we reviewed in our last episode.

Today we’re diving into an issue that’s also quietly eroding the bottom line of many medical groups: claim denials that aren’t followed up. The stats are startling: about 20% of medical insurance claims are denied (yes, you heard that correctly: one‑in‑five) and around 65% of those denials are never appealed or corrected. Put those together and you get this: if 20% are denied, and 65% of those are lost, you’re effectively giving away 13% of your revenue. That’s a huge hit—and yet most practices aren’t managing it as one of their top financial risks. Many aren’t even aware of it. They’ve just gotten used to it over the years as an “acceptable loss.”

This isn’t theory—it’s real work you’ve done, for real patients, with real documentation and care. And if you don’t follow up on denials, you’re essentially saying someone else’s rules are dictating your revenue. For physician groups, this means margin gets squeezed, growth stalls, and independence becomes harder to maintain. All because you’re handing over a bunch of money to the payers.

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Episode 162: Denied and Forgotten: How Medical Claim Denials Are Costing You 13% of Your Revenue

Medical Money Matters with Jill Arena