How Many People Give Up on Legitimate Appeals — and What It Costs Them

The Giving-Up Gap

There is a staggering gap between the number of Americans who receive insurance denials and the number who appeal them. This gap is not accidental. It is the financial foundation of the denial-first insurance model.

Understanding the scale of the problem — and the personal cost of giving up — is the first step to not becoming part of the statistic.

The Numbers

Health insurance denials

A 2023 Kaiser Family Foundation analysis found that ACA marketplace insurers denied approximately 17% of in-network claims. With over 200 million Americans enrolled in private health insurance, tens of millions of claims are denied each year.

The appeal gap

Despite this, fewer than 1 in 1,000enrollees filed a formal internal appeal in the studied plans. That means approximately 99.9% of denied claims were never formally challenged.

Success rates for those who did appeal

Among those who filed internal appeals, approximately 40–60% were decided in the consumer's favor.

The math: millions of Americans give up on claims they would have won.

The Personal Cost of Giving Up

The average denied health insurance claim

The average denied medical claim involves hundreds to thousands of dollars in out-of-pocket costs that should have been covered. For specialty drugs, surgical procedures, and inpatient care, denied claims frequently involve tens of thousands of dollars.

VA benefits

Veterans who give up on incorrect rating decisions leave potentially hundreds of thousands of dollars in lifetime compensation on the table. A veteran who should receive 70% disability instead of 20% — and gives up — loses thousands of dollars per month for the rest of their life.

Social Security disability

The average Social Security disability claimant who gives up after initial denial and never appeals has forgone monthly income for life. At $1,500/month over 20 years, that is$360,000 in foregone benefits.

Unemployment

A person who accepts a wrongful unemployment denial loses an average of $450/week for up to 26 weeks — nearly$12,000 in benefits they were entitled to receive.

Why People Give Up

Confusion

The appeals process is deliberately complex. Bureaucratic language, multiple forms, and unclear instructions discourage people from starting.

Fear of the unknown

Many people don't know what an appeal involves, how long it takes, or whether they need a lawyer. The uncertainty feels overwhelming.

Exhaustion

When you are dealing with a medical crisis, a disability, or financial pressure, fighting an insurance company feels like one more impossible task.

Disbelief that it will work

People assume the system is rigged and their appeal has no chance. The data shows otherwise.

What Changes the Outcome

The single most predictive factor in whether someone pursues an appeal is whether they have access to clear, actionable information at the moment they receive the denial — not days later when the urgency has faded.

ClaimCompass exists to close that gap. Upload your denial within minutes of receiving it. Know your chances in 15 seconds. Fight back —free.

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