What is the dollar amount of INCORRECTLY denied medical claims in the United States ??? Below are my calculations.

For years health plans have used technology to process and deny claims. Tal Shulman and I started Protego Health to help providers automate the process of appealing denied medical claims to even the playing field. By intervening before a bill hits patient responsibility, we can help both providers and patients like my brother, who was hit with $1 million in bills after multiple surgeries for Colitis.

In one of the most comprehensive studies on denials to-date, in 2017, Change Healthcare found that there were $263 billion in initially denied claims within hospitals and health systems (https://bit.ly/3Bap82U).

Applying an inflation calculator to that number (https://bit.ly/4fdRW8D), we find that $263 billion becomes $334 billion in 2024 dollars. Change Healthcare also noted a 23% increase in denials between 2016 and 2020 (https://bit.ly/3ZtlEAE). If we conservatively assume another 15% between 2020 and 2024, that $334 billion becomes $461 billion. In 2022, according to CMS, Physician and clinical services ($884 bn) were 65.5% of hospital services ($1.35 bn) (https://bit.ly/41uW1SE). Using that same logic, if we multiply $461 bn by 1.65, we get  $737.8 billion.

Some denials are correct - providers bill incorrectly, or bill for services that are not medically necessary. But going back to that initial report, Change noted that 63% of denials were recoverable. 63% of $737.8 bn is $465.8 bn. If correct, that means that a dollar amount approximately equal to the GDP of Israel is incorrectly denied by America's health insurance plans each year.