When a patient receives medical care in the U.S., it kicks off a notoriously complex billing process. Providers like hospitals, health systems or ambulatory care facilities submit an invoice called a claim to an insurance company, and the insurer will approve or deny the claim based on whether or not it meets the company's criteria for reimbursement.
If a claim is denied, patients are often responsible for covering the cost out-of-pocket. More than 450 million claims are denied each year, and denial rates are rising, Waystar said.
Providers can ask insurers to reevaluate claim denials by submitting an appeal letter, but drafting these letters is a time-consuming and expensive process that doesn't guarantee a different outcome.