Percentage of initial denials overturned, by payer type

Fifty-four percent of denials from private payers that were initially denied were ultimately overturned and paid, “but only after multiple, costly rounds of provider appeals,” according to a March 21 report from healthcare solutions company Premier. 

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By: Andrew Cass

Premier conducted a survey of hospital and health system leaders representing 516 hospitals across 36 states between Oct. 10 and Dec. 31, 2023. The respondents were asked to consider all claims from Jan. 1 to Dec. 31, 2022.

Here is the percentage of initial denials overturned, by payer type, according to the report: 

Commercial: 60.5%

Medicare Advantage: 52.7%

Managed Medicaid: 49.7%

Medicare: 50%

Medicaid: 45.8%

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