39
prior authorizations per physician, per week
AMA 2024
The burden
Denials are common — and a small practice has no department for them.
On the ACA marketplace, insurers denied 19% of in-network claims in 2024, with rates ranging from 3% to 36% across insurers.1 A hospital absorbs that with an appeals team. A one-to-ten-provider practice absorbs it with the same people who room patients, answer phones, and close the day — which is why so much of it never gets worked at all.
The write-off is rarely a decision. It’s the default that happens when a denied claim lands on a desk that has no free hour. We’ve traced where that hour actually goes in thirteen hours a week.
<1 in 100 denials appealed the rest are left on the table1
Your week
The time you don’t have, measured.
Prior authorization alone — before a single denial is appealed — consumes a startling share of a practice’s week, per the AMA’s 2024 physician survey:2
~13 hrs
physician + staff time on PA, per week
AMA 2024
40%
of practices have staff working PA exclusively
AMA 2024
89%
say PA increases physician burnout
AMA 2024
Against that, reworking a single denied claim costs roughly $25 in staff time3
— which for many routine claims approaches or exceeds what the claim itself pays. That math is exactly why
the small-dollar denials get abandoned, and exactly the math automation changes.
When the cost of fighting a claim is close to the claim’s value, giving up is the rational move — and it compounds, claim after claim. We walk through that arithmetic in the economics of giving up.
The gap
The denials you don’t fight are usually the ones you’d win.
Here is the part that makes the write-off sting. When patients and practices do push back, they win a lot: across Medicare Advantage in 2024, 80.7% of appealed denials were overturned — yet only 11.5% were ever appealed.4 The Commonwealth Fund found that among privately insured adults who appealed a prior-auth denial, more than half got coverage (30% for the recommended care, 25% for an alternative).5
Patients who didn’t appeal often skipped it “because they are unsure they have the
right to challenge the decision or because they doubt it would make a difference.”Commonwealth Fund, 2025 affordability survey
The same is true on the practice side. The barrier almost never is that the denial is unbeatable. It’s that filing the appeal takes time a small practice can’t spare — so winnable money is left on the table by default, not by decision. That silence carries downstream, too: what a written-off denial costs the patient is the subject of the patient side of the denial.
<1%
of marketplace denials appealed
KFF · 2024
80.7%
of MA appeals overturned
KFF · 2024
>50%
of PA appeals won coverage
Commonwealth · 2025
A denial appealed wins far more often than not. A denial never appealed wins zero percent of the time
— and that is where nearly all of them sit.
Why now
Administrative weight is pushing independents to sell.
The share of physicians in private practice fell to 42.2% in 2024, down from about 60% in 2012, and the AMA names inadequate payment and administrative and regulatory burden among the leading reasons.6 Denials and prior auth are a large, daily part of that weight. Keeping a practice independent increasingly means finding leverage on exactly this kind of work — recovering the revenue without adding the headcount.
42.2%
of physicians in private practice, 2024
AMA · down from ~60% (2012)
93%
say prior auth delays needed care
AMA · 2024
~$25
staff cost to rework one claim
MGMA / Change Healthcare
The way to stay independent isn’t to work harder on the same denials — it’s to make each one
cheap enough to fight that the winnable ones stop getting written off.
The move
A finished appeal from a denied EOB — no new hire.
Merits Appeals turns a denied EOB into a ready-to-send, payer-specific appeal in minutes: the denial-reason rebuttal, the medical-necessity argument, and the payer’s own policy, cited — assembled from the denial and the chart, every detail verified verbatim. No new workflow and no appeals desk to staff; you review and send. The point isn’t to win more of the appeals you already file. It’s to make filing cheap enough that the winnable denials stop getting written off.
01
Upload the denied EOB
Drop in the remittance and the relevant chart detail. No EHR integration, no IT ticket.
02
The draft assembles
Denial-reason rebuttal, medical-necessity argument, and the payer’s own policy — each detail cited to a named, verbatim source.
03
You review
Unsupported claims surface as flags you must clear. Nothing leaves without a physician’s attestation and signature.
04
Sign and send
A ready-to-file appeal, on the provider’s letterhead — in minutes, not the hour no one had.