Calculator
Denied revenue calculator
Insurers on HealthCare.gov plans denied 19% of in-network claims in 2024, and consumers appealed fewer than 1% of those denials, according to KFF. Enter your own volume and appeal results to see what unappealed denials cost each month.
Denied-revenue picture
Dollars denied per month$39,900
Recovered at your appeal rate$5,426
Left on the table each month$6,783
Illustrative estimate from your inputs. The default denial rate (19%) and appeal win rate (34%) come from KFF’s analysis of 2024 HealthCare.gov marketplace claims, across all services, not behavioral health specifically. The achievable scenario assumes 90% of denials get a documented appeal. Your remittance data measures the real figures.
Interpretation guide
How to use this number
Use the output as a decision aid: verify the inputs, read the operational signal, then choose what to measure or change next.
Start from your remittance data
Pull last quarter's claim count, denial rate and average allowed amount from your clearinghouse or billing reports rather than guessing.
Be honest about your appeal rate
Count only denials that were actually appealed in writing or resubmitted with new evidence, not denials someone looked at.
Use your own win rate when you have it
The 34% default is an all-services marketplace figure. If you track appeal outcomes by payer, your own rate is the better input.
Read the bottom line as a monthly habit
The unrecovered figure recurs every month you leave the appeal workflow understaffed. It is a rate, not a one-time amount.
Method & assumptions
Dollars denied equal monthly claims times denial rate times average claim amount. Recovery applies your current appeal rate and your appeal win rate. Defaults come from KFF's analysis of 2024 HealthCare.gov marketplace claims: 19% of in-network claims denied, and insurers upheld 66% of internal appeals, so about 34% succeeded. Those figures cover all services, not behavioral health specifically. The achievable scenario assumes 90% of denials get a documented appeal. Source: KFF, Claims Denials and Appeals in ACA Marketplace Plans in 2024.
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