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The Goodman Institute Health Blog

MA Plan Claim Denials

Posted on June 2, 2025 by John C. Goodman

We found that 17.7 percent of claims were denied … that 60 percent of all denied claims were resubmitted, with two-thirds of resubmitted denials being overturned….   Overturned denials constituted 56.6 percent of original denials, as a dollar share of billings. Providers therefore ended up losing 7.2 percent of the total dollars they initially billed for….

Even after we factored in denials that were overturned, net denial rates … were 8.0 percent for non-inpatient institutional compared with 7.0 percent for inpatient and physician services.

Source: Health Affairs

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For many years, our health care blog was the only free enterprise health policy blog on the internet. Then, when the NCPA closed its doors, the health blog stopped as well.

During this five-year hiatus no one else has come forward to claim the space. So, my colleagues and I have decided to restart the blog in connection with the Goodman Institute. We invite you and others to use this forum to share your views.

John C. Goodman,

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