If you suddenly found yourself working for an insurance company and received a claim that looks like this for MRI--

[Silent Type]

13. One more time. Those are INITIAL denials -- similar to examples above -- that are overturned in over 80% of cases

because the provider sends in the requisite info. And it happens with government programs like Medicare and Medicaid too.

Oh, before you ask what happens to the other 20%, I'll answer.

In many cases the provider reads the coverage policies -- which, again, are usually just like Medicare's coverage policy -- and says, "Oh they are right, we'll try that other stuff and if patient is still having an issue order an MRI." Or they go, "Oh, chit, we put the wrong codes on the form, not wonder they denied our Preauthorization.

There is some portion of claims and preauthorizations that are never approved. Maybe by error, maybe intentionally, maybe the provider is a quack trying to do Chelation therapy or something, etc. In the latter case, they'll never respond and go look for another insurer who they can sneak the claim through.