A quarter of U.S. healthcare spend never reaches a patient. It disappears into claims friction, prior auth overhead, denials rework, and FWA. Here is exactly where it goes — and what it costs to stop it.
The U.S. spends more on healthcare administration per capita than any other nation — by a factor of three. The waste lands hardest on Payors, MCOs, TPAs, and RCMs who sit at the center of every transaction. Five drains account for the majority of it.
Every dollar lost to administrative waste is a dollar that left your members' care — and landed in a process that delivered no clinical value to anyone.
9B+ claims/yr at $12–$40 each. MA denials up 55.7% in one year. 65% of denied claims are never resubmitted — revenue simply gone.
53M PA determinations in MA in 2024. Each costs $40–$50 per payer submission. Appeals rose from 7.5% to 11.5% in five years.
Hospitals spent $43B in 2025 collecting payments insurers already owed. $18B was spent overturning inappropriate denials alone.
FWA costs $60B+ annually. Most is detected post-payment — or not at all. Real-time detection alongside billing would eliminate the lag entirely.
HFMA and TruBridge estimate $9.8B in savings from AI-powered RCM automation alone. Automating just 9 common transactions saves $20B+ annually (CAQH 2024). Yet only 25% of payers have an AI strategy. Claims that take 4–6 weeks to process manually resolve in hours with modern automation. The average hospital dedicates 64 billing staff — 6.5% of total headcount — to work that automation handles continuously, without error.
75% of payers have no AI strategy. They are not saving money by waiting. They are spending it — at a rate of billions per year.