I run a company that services over $2.5B in healthcare claims. Nearly all of them, and I mean close to one hundred percent, were denied the first time they were submitted. Not flagged. Not questioned. Denied.
That statistic used to bother me because it looked like a failure somewhere in the process. It took me years in this business to understand it is not a failure at all. It is the process. Denial first is the default posture of most third-party liability carriers and health insurers, and it is the reason medical liens exist as a mechanism in the first place. A lien is not a workaround. It is the tool that lets a doctor treat a patient who cannot pay out of pocket, on the promise that payment will eventually come once a claim gets sorted out, however long that takes.
The Default Answer Is No
Here is what most people do not understand about denied insurance claims. A denial is rarely a judgment on whether care was necessary. Someone gets hit by a tractor trailer. They break an arm, or worse, they suffer a traumatic brain injury and cannot work. The claim tied to that injury gets denied anyway, and then the finger pointing starts. The health insurer says talk to the liability carrier. The liability carrier says talk to the health insurer. Meanwhile the provider who treated the patient is carrying that cost on their books, unpaid, sometimes for years, until litigation or negotiation resolves it.
This is where medical liens do their real work. They let a provider extend care now against a future recovery, instead of turning away a patient who has no savings and no clear payer. And that gap is bigger than most people realize. Roughly 30 million Americans are uninsured. Another 100 million have less than four weeks of expenses in the bank. If you or someone in your family gets hurt and you fall into either group, there is almost no scenario where you receive care without some version of this lien structure standing behind you.
Think about what that actually means for a provider’s business. They are being asked to deliver care on faith, front the cost of treatment, and then wait through a claims process that was designed to slow them down rather than speed them up. That is not a small operational detail. It is the central financial risk that most healthcare practices carry, and very few of them have the staffing or the systems to manage it well on their own.
I did not build a business around denials because I think the system should work this way. I built it because until the system changes, someone has to sit in that gap, and most companies are not built to do it well.
Why the Waste Is the Point, Not a Side Effect
People love to argue about single payer versus private healthcare like it is a binary choice. I have lived in Japan, the UK, France, Sweden and Switzerland, so I have seen a variety of healthcare models up close. Single payer systems do not have the same research and development capacity we have here, and they ration access in ways that are dangerous for anyone with a serious or complex condition. Our system has the opposite problem. It is a for-profit private sector with a bifurcated public overlay, and in a system like that, waste is not a bug. Administrative waste sits somewhere north of 40 percent of every dollar spent, and a sizable share of that comes from the denial and appeal cycle itself. Claims get denied, resubmitted, denied again, escalated, and eventually paid or litigated, and every one of those steps costs money that never touches patient care. Multiply that across billions of dollars in annual claims volume and you start to see why premiums keep climbing while reimbursement to the providers actually delivering care keeps shrinking.
The fix is not choosing between capitalism and socialism. It is running healthcare more like a regulated utility. A utility gets to earn a profit, but it also has an obligation to reinvest in the infrastructure that keeps it running efficiently for the people who depend on it. Right now, too much of the healthcare industry keeps the profit motive and skips the reinvestment obligation. That imbalance is what pushes the burden of unpaid claims onto providers and the burden of delayed care onto patients, which is exactly where our servicing work sits.
Speed Is Available. We Just Do Not Use It
I know the system can move fast when it has to, because I have seen it happen inside my own company. When the shutdown hit, we moved a workforce of one hundred people to fully remote operations in a single week, while still managing complex claim documentation for healthcare providers across the country. Technology we assumed would take a year to roll out got deployed in days. That experience changed how I evaluate every roadmap I look at now, whether it is our own or a company I advise. If a 12-month goal can be compressed into six weeks under pressure, the 12-month timeline was never really a technical constraint. It was an organizational choice.
That same speed is available for claims processing and provider reimbursement, if the industry decides reducing denial cycles matters as much as protecting margin. Fewer back and forth cycles on necessary care. Faster resolution for providers carrying receivables on lien. More dollars redirected toward proactive health investment instead of administrative churn.
What This Means for Providers and Patients
None of this changes by waiting for policymakers to rewrite the rules. It changes when the operators inside the system, the revenue cycle management companies, the servicing partners, the providers themselves, decide to run their piece of it with more discipline than the carriers they are negotiating against. That is the only lever most of us actually control.
Nearly one hundred million Americans depend on some version of this gap being covered by someone willing to do the unglamorous work of collecting on claims that should have been paid the first time. Medical liens are how that gap gets bridged today. The bigger opportunity is building a system where the gap does not need bridging nearly as often, and that starts with treating denial first as a choice the industry is making, not a fact of how healthcare has to work.
*This article was influenced by a conversation I had on the Famous Interviews with Joe Dimino podcast, where we got into how claims actually move through the system and why that gap needs bridging in the first place. Give it a listen here: https://podcasts.apple.com/us/podcast/reid-zeising-interview-gain-health-tech-innovation/id1660256991?i=1000774185812.*