The Denial Economy
Data journalism on the market's numbers
Less Than 1%: America's Appeal Gap
85 million denied claims, 262,982 appeals — the funnel of giving up, told only with public data.
No. 021 in 5: The State of In-Network Denials
The annual brief on marketplace denial rates, in six charts.
No. 03Denied for “Other”
36% of denials carry no legible reason. The black box, quantified.
No. 04The $25.7 Billion Rework
What administering denials costs the American provider every year.
No. 05What One Denial Costs a Small Practice
The $25–$118 range, methodology open — adjust the inputs yourself.
No. 0641% and Climbing
Three years of the State of Claims series: the denial burden keeps rising.
No. 26Paid in Part: The Underpayment Problem
The money that disappears inside claims marked “paid.”
No. 31A Brief History of the Denial
From 1970s utilization review to algorithmic claims editing.
No. 32Only in America: Administrative Cost in Perspective
US billing-and-insurance costs against comparable systems, from the peer-reviewed record.
No. 33The 25-Minute Phone Call
The economics of every single interaction with a payer.
The Transparency Files
Analysis of the public disclosure data
Denial Rates by Insurer
156 reporting issuers, from 3% to 36% — the spread nobody sees on a member card.
No. 08Denial Rates by State
The geography of the in-network denial.
No. 09Upheld: What Happens When You Appeal, by Payer
Internal-appeal uphold rates, issuer by issuer.
No. 10The External Review Scoreboard
What actually wins when an independent reviewer decides.
No. 11The First Mandatory Prior-Auth Disclosures Are Out
What the post–March 2026 reports show — and what they still hide.
No. 12Medicare Advantage's 13%
The prior-auth denials that met Medicare's own coverage rules.
No. 27The Deadline Asymmetry
Filing windows shrink for providers while payer clocks stay comfortable.
No. 29The Parity Test
Behavioral health becomes the first service line with its own denial data.
No. 34The IDR Scoreboard
Who's winning the No Surprises Act arbitrations, quarter by quarter.
Policy Watch
The rules that change the game
The Pledge Tracker
What ~60 insurers promised for 2026 and 2027 — against what physicians report.
No. 14WISeR, Explained
The AI prior-auth pilot inside traditional Medicare, and what changes in 2026.
No. 15Full and Fair Review: Your ERISA Rights as a Provider
29 CFR 2560.503-1, in plain English.
No. 16The State Prior-Auth Reform Map
Gold-carding, response deadlines, and peer-review requirements, state by state.
No. 17When Payers Automate Denials
The public record on algorithmic review — and the standard that's missing.
No. 25The Quiet Downcode
When the payer doesn't deny — it pays you less. The E/M downcoding record.
No. 30Rule Churn: Telehealth
The category where the rule's own instability manufactures the denial.
The Practice Under Pressure
The economics of the small practice
13 Hours a Week
The prior-authorization tax on a small practice, translated into FTEs and dollars.
No. 19The Economics of Giving Up
Why practices rationally don't appeal — and what would have to change in the math.
No. 20What Reviewers Actually Read
Clinical documentation that survives a medical-necessity review.
No. 21The Patient Side of the Denial
What the insured public lives through — and why the front desk feels it.
No. 22Appeals per FTE: The Small-RCM Benchmark
How much denial work a small team can actually carry.
No. 28Who Still Works the Denials?
Denials rising, the workforce that fights them shrinking.
Benchmarks & Tools
Interactive pieces on public data