Why claim denial rates are rising in 2026

If it feels like more claims are denying than they used to, the recent survey data agrees with you, and it is not close. Two of the industry's most closely watched sources, the American Hospital Association and Experian Health's annual provider survey, both independently describe the same direction of travel: denials up, appeals underused, and providers increasingly convinced the trend is not slowing down.

What the AHA data actually shows

The American Hospital Association's reporting on commercial insurer denial tactics puts overall initial denial rates at 15.7% for Medicare Advantage claims and 13.9% for commercial claims. More strikingly, the AHA's analysis found care denials increased an average of 20.2% for commercial plans and 55.7% for Medicare Advantage plans between 2022 and 2023, a sharp acceleration rather than a gradual drift. Hospitals themselves feel this directly: in AHA's own survey work, 78% of hospitals and health systems reported that their experience with commercial insurers had gotten worse, against just 1% reporting improvement.

The AHA's January 2026 testimony to the House Ways and Means Committee continued pressing the same theme into this year, arguing that administrative burden from denials and prior authorization remains one of the largest cost drivers hospitals face, separate from the clinical cost of care itself.

What the provider-side survey data shows

Experian Health's State of Claims survey, based on a survey of 250 healthcare professionals conducted in mid-2025, found 41% of providers report claim denial rates above 10%, up from 38% in the prior year's survey and 30% in 2022, a consistent, multi-year climb rather than a single bad year. The same survey found 68% of respondents say it is more difficult to submit a clean claim than it was a year earlier, and 54% reported an increase in claim errors overall.

The part of the story that gets less coverage: appeals still win

Rising denial rates are only half the picture, and arguably not the more actionable half. As our guide to writing a reconsideration request covers, HFMA's own reporting, citing analytics firm Kodiak Solutions, puts the overturn rate on filed appeals at roughly 70% industry-wide. The Kaiser Family Foundation's January 2026 analysis of 2024 Medicare Advantage prior authorization data found that only 11.5% of denied requests were ever appealed to the insurer at all, even though 80.7% of the ones that were appealed were partially or fully overturned. A high win rate sitting next to a low filing rate is not a coincidence: the bottleneck for most practices is not whether the argument holds up, it is whether anyone has time to write it.

What is actually driving the increase

• Stricter documentation and prior authorization requirements. Both the AHA and Experian Health data point to payers applying more granular review criteria than in prior years, which raises the odds any single claim trips an edit or a documentation gap.
• Errors on claims climbing alongside denial rates. Experian's finding that 54% of providers report more claim errors suggests some of the increase is preventable at the scrubbing stage, before the claim ever reaches the payer.
• Underused appeal capacity. With overturn rates around 70% and appeal filing rates in the low double digits for some denial categories, a meaningful share of the reported "denial problem" is actually an unresolved-appeal problem.

None of this changes what an individual biller does differently on a Tuesday morning. It does argue for two specific habits: catching preventable errors before submission, since a rising share of denials trace back to correctable claim-level issues rather than genuine coverage disputes, and treating a denied claim as a default candidate for reconsideration rather than a write-off, given how consistently high the overturn rate stays once someone actually files.

Where this leaves a billing office right now

The practical read is not that denials are unstoppable, it is that the return on fixing preventable ones, and on filing the appeals that already win most of the time, has gone up alongside the denial rate itself. Reading the CARC and RARC pair correctly before deciding whether to correct, appeal, or write off a claim matters more, not less, in a year where the denial volume keeps climbing.

Frequently asked questions

Are claim denial rates actually going up, or does it just feel that way?

The data supports the perception. Experian Health's survey shows the share of providers reporting denial rates above 10% has climbed for three consecutive survey years, and AHA reporting shows a sharp year-over-year increase in care denials between 2022 and 2023 specifically, not a one-time anomaly.

Which payer type denies the most claims?

AHA's figures put Medicare Advantage initial denial rates at 15.7%, higher than the 13.9% reported for commercial claims overall, though individual commercial payer rates vary considerably and are not broken out uniformly across public reporting.

Is the rise in denials mostly about medical necessity, or something else?

The available survey data points more toward documentation, submission errors and administrative requirements than toward a wave of new medical necessity disputes specifically. Experian Health's finding that submitting a clean claim has gotten measurably harder for most providers supports that reading.

If overturn rates are so high, why don't more practices appeal?

The most consistent explanation across industry reporting is capacity, not confidence in the argument. Writing a citation-specific reconsideration takes time a busy billing office often does not have, which is exactly the gap that structured templates and automation are increasingly being built to close.