Case Study: How We Recovered $600 in Denied Claims Using Manual Insurance Appeals
- Soendeep Kaur
- Dec 4, 2025
- 2 min read
Industry: Medical Billing
Client Type: Solo Private Practice
Service: Insurance Billing, Retro Authorization & Appeals
Outcome: 100% Recovery of Denied Claims
Overview
This medical billing case study highlights how our team successfully recovered nearly $600 in denied insurance claims for a solo provider using a fully manual appeals process—after the payer eliminated all electronic submissions.
Despite not being contractually responsible for prior authorizations, our team stepped in to protect the provider’s revenue and prevent permanent financial loss.
The Problem: Denied Claims Due to Missing Prior Authorization
Over a 45-day period, a provider unknowingly completed four patient visits without valid prior authorization due to a breakdown in referral communication.
This resulted in:
4 denied insurance claims
$150 per visit
Total revenue at risk: $600
To complicate matters further, the provider’s IPA had recently stopped accepting electronic appeals. From that point forward, all appeals had to be submitted via certified paper mail only.
This created several challenges:
Manual document preparation
Certified mail tracking
Extended processing timelines
No online claim status visibility
At this point, the provider believed the revenue was permanently lost.
Important Context: This Was Not Our Responsibility
It’s important to clarify:
We were only hired for billing services
We were not responsible for prior authorizations
We were not responsible for retro authorization requests
There was no additional financial incentive for pursuing these appeals
However, because this was a solo practice, the provider did not have the staff or time to manage certified mail appeals independently.
We made the decision to step in anyway.
Our Solution: Manual Retro Authorization & Paper-Based Appeals
Our team initiated a full manual retro-authorization and appeals process, which included:
Preparing full retro authorization requests
Attaching complete SOAP notes
Drafting formal appeal explanation letters
Sending documentation via certified paper mail
Tracking physical delivery confirmation
Performing repeated payer follow-ups
After 20–25 days, no response was received.
At this stage, many billing teams would stop.
We didn’t.
We re-submitted:
New certified mail packages
New tracking numbers
Fresh follow-up cycles
Additional payer escalations
The Result: 100% of Denied Claims Recovered
After approximately 45 days, all four denied claims were fully paid.
Total recovered: $600. Recovery rate: 100%
The provider was genuinely surprised—and relieved—that the revenue was successfully recovered after being written off emotionally.
Why This Case Study Matters
This case demonstrates an important truth in revenue cycle management:
Practices rarely lose the most money from large billing errors. They lose it from small denials that become too exhausting to fight.
When billing becomes manual and time-consuming:
Retro authorizations get delayed
Appeals get abandoned
And revenue slowly leaks without visibility
This case reflects our commitment to:
✅ Revenue ownership
✅ Ethical billing partnerships
✅ Process persistence
✅ Denial and appeal endurance
Final Takeaway
While our firm does receive a percentage of collections, this case offered:
No bonus
No special compensation
No guaranteed recovery
We pursued this recovery for one simple reason:
It was the right thing to do for the provider.
Dealing With Denied Claims or Manual Insurance Payers?
If your practice is experiencing:
Retro authorization denials
Paper-only insurance appeals
Staff burnout from follow-ups
Or repeated claim write-offs
You’re welcome to reach out for a second opinion on what is actually recoverable.
