Data · Published Jun 4, 2026
54% of Denied Claims Get Paid on Appeal, If Someone Appeals
More than half of appealed private-payer denials are overturned, and prior auth appeals do far better. Yet most denials are never appealed. Here is the appeal data, what it means for your practice, and how to decide which denials to fight.
Jareer Ali·
Research & field notes·
11 min read
More than half of appealed private-payer denials are overturned (about 54%, Premier), and prior authorization denials succeed on appeal the large majority of the time, yet most denials are never appealed and fewer than 1 in 5 physicians always appeal. The money is winnable. The problem is that almost nobody pursues it, which makes appealing the highest-return habit in the revenue cycle.
Key takeaways
- About 54% of appealed private-payer denials are overturned (Premier). The majority of appeals win.
- Prior authorization denials do even better, overturned the large majority of the time on appeal, roughly two-thirds to over 80% depending on the payer and year (KFF; AMA).
- Yet most denials are never appealed, and fewer than 1 in 5 physicians always appeal PA denials (AMA, 2024).
- Reworking a claim costs about $57.23; the recovered claim is usually worth far more. The math favors appealing.
- The fix is to make appealing the default: log every denial with its deadline and work it before the window closes.
The appeal numbers
Every figure sourced and dated. Read them together and one conclusion is unavoidable: denials are far more winnable than practice behavior assumes.
| Number | What it means | Source |
|---|---|---|
| ~54% | Appealed private-payer denials that are overturned | Premier |
| a large majority | Prior authorization denials overturned when appealed | AMA / KFF |
| <18% | Physicians who say they always appeal prior auth denials | AMA, 2024 |
| Most | Share of denied claims that are never appealed at all | Industry, multi-year |
| ~$57.23 | Administrative cost to rework a single denied claim (2023) | Premier, 2023 |
What the numbers say together
Line the figures up and the story writes itself. Denials win on appeal more than half the time, prior auth denials win the overwhelming majority of the time, and yet fewer than one in five physicians always appeal and most denials are never appealed at all. The gap between how often appeals succeed and how often they are filed is the single largest pool of recoverable revenue in most practices. This is not a story about tough payers, though payers are tough. It is a story about a winnable fight that practices decline to have, usually because no system made appealing the default. The revenue is sitting there, already earned, waiting on a process that never happens.
The cost and benefit of appealing
Is it worth the effort? Run the math. Reworking or appealing a claim costs roughly $57.23 in administrative time Premier, 2023. The claim being recovered is frequently worth many times that, hundreds or thousands of dollars. Combine that with a better-than-even chance of winning a private-payer appeal and a strong chance on a prior auth denial, and the expected value of appealing a winnable denial is strongly positive. Put simply: you spend tens of dollars for a majority shot at recovering hundreds. There are denials not worth chasing, a tiny claim with a weak case, but they are the exception. For most, declining to appeal is declining free money, and doing it at scale is how a practice quietly writes off a chunk of its revenue every year.
Which denials to appeal
Given the odds, the default should be to appeal, and the question is really which few to skip. Appeal anything with a fixable or arguable reason: medical necessity denials with clinical support, authorization issues where an auth existed or should have, coding denials that are correctable, and eligibility errors that can be fixed and resubmitted. Weigh claim value against effort only at the margins, a very small claim with a genuinely weak case may not be worth it. But treat that as the rare exception, not the rule. The practices leaking the most are not the ones appealing the wrong denials; they are the ones appealing almost none, so the correction is not better selection, it is simply appealing far more of them.
The appeal process and deadlines
An appeal is a sequence on a clock. Identify the denial reason and gather the support, the clinical note, the corrected code, the proof of eligibility or authorization. File within the payer's appeal window, which varies by payer and is unforgiving once passed. Escalate through levels if the first is denied, and for clinical denials, use the peer-to-peer review where offered. The deadline is the part that ends careers of otherwise-winnable claims, because a perfect appeal filed a day late recovers nothing. This is why appeals belong in a tracker built around deadlines rather than in an inbox, so the window is visible before it closes, not after.
How to stop leaving the money
The fix is not to appeal harder, it is to make appealing automatic. Log every denial the day it lands, with its reason, value, and appeal deadline. Work each one before its window closes. Track recovery so the returning money is visible and the habit sticks. That is precisely what the free denial and AR tracker is built to do, with deadline alarms and a recovery dashboard. Pair it with prevention at the front end, since the cheapest denial is the one that never happens, using eligibility verification and prior auth denial prevention, and see the full denial picture in the denial statistics. Appealing is the highest-return habit in the revenue cycle; the only thing missing is a system that makes it the default.
Sources
- Premier Inc., Trend Alert: Private Payers Retain Profits (denials overturned on appeal)
- Premier Inc., Claims Adjudication Costs Providers $25.7 Billion (2023 rework cost)
- American Medical Association, Prior Authorization research and physician surveys
Primary sources linked above. Figures are cited with their publication year; confirm the latest release for time-sensitive data.
Where to go next
- Denial and AR Follow-Up Tracker (Free): Work Every Denial to Paid live
A free denial and AR follow-up tracker: log every denial with its appeal deadline, work each to.
- Insurance Eligibility Verification Checklist (Free Download) live
A free insurance eligibility verification checklist: the pre-visit checks for coverage, IDs,.
- Reduce Prior Auth Denials: The Log + Prevention Checklist System live
Reduce prior auth denials: a prevention checklist that stops the common causes before.
Find the leak before you fix it
Two ways to start, both free.
Run the free Rescue Kit and its tools yourself, or book a 20-minute Leak Audit where we put a real number on what this is costing, using your own volume. A diagnosis, not a pitch.
Frequently asked questions
What percentage of denied claims are overturned on appeal?
More than half of appealed private-payer denials are overturned (about 54%, Premier), and prior authorization denials do even better, succeeding on appeal the large majority of the time, from about two-thirds in Medicare Advantage to over 80% in older analyses (KFF, 2024 data; AMA). The money is winnable; most of it is simply never pursued.
How many denials are never appealed?
Most of them. A large majority of denied claims are never appealed at all, and fewer than 1 in 5 physicians say they always appeal prior auth denials (AMA, 2024). Every unappealed winnable denial is earned revenue written off.
Do prior authorization appeals succeed?
Usually, yes. When prior auth denials are appealed, they are overturned the large majority of the time, the large majority in analyses of the data (AMA; KFF). A high PA denial rate paired with a low appeal rate is money left on the table by default.
Is it worth appealing denials?
For most winnable denials, yes. The administrative cost to rework a claim is around $57.23, while the recovered claim is often worth far more, and more than half of private-payer appeals succeed. The math favors appealing anything with a real chance.
Which denials should I appeal?
Appeal denials for reasons that are fixable or arguable: medical necessity, authorization issues, coding, and eligibility that can be corrected. Weigh the claim value against the effort, but given the overturn rates, the default should be to appeal, not to write off.
How do I stop leaving appeal money on the table?
Make appealing the default, not the exception. Log every denial with its appeal deadline, work each before the window closes, and track recovery so the effort is visible. A denial tracker turns appealing from a scramble into a routine.
- Premier. premierinc.com
- AMA / KFF. ama-assn.org