A doctor and a patient in a medical consultation room. The patient is sitting on a stool, talking and gesturing with her hand. The doctor is standing with arms crossed, listening. Medical images and an electrocardiogram are displayed on the wall behind them, along with a table holding medicine pills and a cup.

Health insurance claim denials have a significant impact on both patients and healthcare providers. For patients, denied claims lead to financial stress, confusion, and delayed treatment, while doctors face administrative burdens and frustration due to inadequate insurance reimbursement.

This strain can affect the overall doctor-patient relationship and diminishes the level of care delivered, as providers become more cautious in recommending treatments that risk being denied.

Additionally, the process of getting denials approved and paid adds to administrative overhead, driving up overall healthcare costs and diverting resources away from patient care.

$4.5 Trillion in claims are submitted to health insurance carriers annually

>$
4.5

Trillion

More than $4.3 Trillion of claims are submitted to health insurance carriers every year in the USA
15
%*

Denied

$600 Billion Addressable Market
*Based on market reports
+
26
%

Increase

Rise in denials in the last 3 years

The current process to get denials paid doesn’t work

86%

of denials are due to mistakes and errors that can be fixed and re-submitted for payment

A maze with a dotted red path leading from the start to the finish.

Extremely labor intensive

Outline of a hand holding a smartphone with a red question mark on the screen.

Limited automated tools

Stack of claim documents with a diagram showing a warning sign and hazard symbols.

Many denials are never reworked

RESULT:  The denial process has never been properly addressed until NOW