How to Appeal the 850 Million Claims that are Rejected Every Year and Win 70 to 90% of the Time (Ep. 44)
Podcast: Play in new window | Download | Embed
Healthcare claim denials are not rare administrative errors. They are systemic.
In the United States, approximately 850 million insurance claims are denied every year, roughly 17% of all submitted claims. Yet appeal win rates can range from 70% to 90%, raising a critical question:
Why are so many claims denied in the first place?
In this episode, Ralph Weber speaks with physician and Claimable co-founder Warris Bokhari about:
- The economics behind insurance claim denials
- The “98% of eligible claims” narrative, and what it leaves out
- AI-driven denial systems and automated claim edits
- Employer liability under ERISA for denied claims
- Transplant, oncology, and specialty drug denial cases
- The impact of 200–600 day payment delays on hospitals
- How patients and employers can respond effectively
They discuss how insurance denials affect patients, employers, providers, and the broader healthcare system, and why appeals succeed at such a high rate when properly constructed.
For employers sponsoring self-funded health plans, this episode is a critical reminder: you are legally responsible for the decisions made on behalf of your plan.
For patients, it offers practical insight into how to push back, and win.
Ralph Weber, The Benefit Whisperer
Share with a colleague. Email ralph@thebenefitwhisperer.com · (832) 924-3330 · fixmybenefitsnow.com · Schedule a free 15 minute consultation