Why Healthcare Providers Are Spending Billions Just to Get Paid

Getting paid in healthcare should be simple.

It isn’t.

Providers are now spending over $25 billion a year just working through claims. Not because the claims are wrong, but because the process is.

About 15% of claims get denied upfront. That sounds reasonable until you realize most of them are eventually approved and paid anyway.

That means the system is not catching bad claims. It is slowing down good ones.

Every denial triggers the same loop. Review. Resubmit. Wait. Repeat. Weeks turn into months. Multiply that across thousands of claims and the cost explodes.

This is not a technology issue. It is a workflow problem built into the system itself.

Then there is prior authorization. Providers ask for approval before care. They get it. Then the claim can still be denied later.

So now they ask for permission, receive permission, and still have to fight to get paid.

That is not control. That is duplication.

The impact is immediate. Hospitals are operating with tighter margins than they have in years. Cash is delayed. Staff is tied up in administrative work. Investment in care gets pushed out.

At the same time, these inefficiencies drive up costs across the system, contributing to higher premiums.

Nothing about this is accidental. The system is doing exactly what it was built to do.

The problem is what it was built to do no longer makes sense.

Most denied claims end up getting paid. Billions are spent proving what was already true.

Until payer rules are standardized, unnecessary approvals are reduced, and claims are validated before submission, this does not change.

Providers will keep funding a process that works against them.