No one likes rejection. We don’t like being told “no.” Unfortunately, in the world of medical insurance, that is becoming a more common occurrence. Anyone working in the field of healthcare these days is acutely aware that it’s getting harder and harder to get paid. A claim is submitted for a service rendered, and it’s no longer a slam dunk that you’re going to receive reimbursement. Something has changed.
Numbers Don’t Lie
A review of several surveys conducted over the past 12 months lends credence to what we already instinctively know. For instance, a survey performed over the last two months of 2024 by the Healthcare Financial Management Association (HFMA) found that the “greatest threat” to a health entity’s cash flow is the volume of denials from commercial insurance. This was, by far, the leading threat, coming in at a whopping 48%. The next highest category was declining reimbursement rates, at 21%.
According to another survey reviewed, 73% of providers agree that claim denials are on the upswing. We find that 38% of respondents said that at least one in ten claims is denied, with some seeing their claims being denied more than 15% of the time. One organization noted that, while denials from commercial plans rose by 1.5% from 2023 to 2024, Medicare Advantage plans saw a 4.8% spike in denial rates during that same period. And it’s not just denials that are becoming a problem; 67% of survey participants indicated that when these health plans do decide to pony up the cash, it’s taking longer for the funds to be received.
Yeah, something’s up. Let’s face it: the rising costs of healthcare (wages, supplies, infrastructure, etc.), along with an increasingly sicker population—especially with the entry of the Baby Boomer generation into their golden years—is putting a real strain on medical insurance companies who seem to be looking for new and creative ways to avoid these huge payouts; hence, the denials, delays and other tactics to get the provider to simply give up.
Dealing with the Fallout
This troublesome trend of reimbursement rejection is clearly a problem as each denial means extra time and resources spent on the appeals process, with the ultimate hope of eventually getting paid. According to one source, each denied claim costs providers or their billing agents between $25 and $181 to correct and resubmit or straight-up appeal. This is one advantage of partnering with Coronis Health. We don’t like leaving money on the table, and we go the extra mile to obtain payment where payment is rightfully due.
Still, providers of medical services need to be aware that there is an intentional and growing game plan on the part of some payers to put roadblocks in the way of reimbursement. Denial of payment and delaying of payment are part of the strategy. The increase in prior authorizations is another. Since some doctors fail to obtain such authorizations prior to the procedure, that’s just another reason to deny payment after the fact—another poison arrow in the payer’s growing quiver.
And let’s not forget about the role that artificial intelligence (AI) is having in this area. According to a March, 2025 Newsweek article, insurance companies are increasingly using AI to automate claim reviews. The article went on to suggest that, while the use of AI for such tasks is saving insurance companies substantial amounts of money, critical and unfounded errors may result from the inclusion of this technology. Yes, there are increasing reports of inaccurate denials due to the usage of AI in the claim adjudication process.
According to United Press International (UPI), some states (including Colorado, Georgia, Florida, Maine and Texas) have proposed legislation to rein in the use of AI in the insurance context. Indeed, a few have actually passed new AI-related laws, including a 2024 California statute that requires a licensed physician to supervise the use of insurance coverage algorithms.
So, yes, America’s medical professionals and their billing staffs are encountering new obstacles on the road to reimbursement. So what else is new?! It’s just one more dragon to slay—which is why it’s advantageous to team up with us at Coronis Health. We have decades of experience dealing with payer denials. We know the tactics they use to delay, redirect and deny, and we work every day to overcome this on behalf of our clients.