how hospitals navigate insurance claims: FAQs
When a patient leaves the hospital, the work shifts—but it does not stop.
After care is delivered, hospitals enter a second phase of work that most patients never see: navigating insurer rules, documentation requests, delays, denials, and appeals so claims can move forward, and patients can get the coverage they deserve. That work is essential, time-consuming, and shaped by a system hospitals do not control.
WHAT PATIENTS DON’T SEE
Delays, denials, and repeated reviews in the claims process create real pressure on hospitals.
- Once a patient leaves the hospital, the claim moves into a process shaped by insurer rules, timelines, and documentation requirements.
- Even well-documented claims can be delayed, sent back for more information, or pulled into additional review.
- Submitting a claim is only the beginning. Many claims require repeated follow-up, rework, and resubmission before they are resolved.
What that means:
- For patients: uncertainty about what they owe and when they will get answers
- For hospitals: burdensome work long after the care itself is complete and ongoing uncertainty around payment for care provided
HOW OFTEN DO DELAYS AND DENIALS HAPPEN?
Delays and denials are not rare exceptions. They are a routine part of the system hospitals must manage every day. When payment is harder to secure, hospitals carry more of the administrative and financial burden tied to care that has already been delivered.
Tennessee Hospital Association data shows:
- In Tennessee, nearly 1 in 5 claims are not paid within the expected time frame.
National data shows:
- 15% of insurance claims are initially denied, requiring hospitals to take additional steps before payment can occur.
- Many denied claims are later approved on appeal, meaning hospitals are often forced to rework claims for care that was ultimately eligible for coverage.
- Each denied claim can cost providers $25 to $118 to rework and appeal.
What that means: Each extra round of review adds more time, more cost, and more uncertainty for both hospitals and patients.
3 REASONS WHY THIS MATTERS TO TENNESSEANS
- Delays, denials, and repeated reviews in the claims process create real pressure on hospitals.
- Over time, the administrative and financial pressure from delayed and denied claims makes it harder to sustain the services communities rely on every day.
- When hospital resources are strained, that friction shows up in patient access to care.
Tennessee hospitals are here for patients at every step behind the scenes, even after they leave the hospital.
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