A decent number of insurance claims are just going to be denied right away. The insurance companies are just trying to see who will and won't follow up on denied claims. Even if you've received prior authorization, documented medical necessity correctly, done everything right....the insurance company might still deny it and sometimes give no reason or a bogus reason.
If you've got good processes in place, good medical records that properly document medical necessity, you're getting authorizations, then you've got a really good shot at winning an appeal. We walk our clients through their options before we appeal. Some claims we've taken all the way to the state insurance commissions and won.
We typically collect on somewhere between 85-90% of the appeals we file.