By Dr. Ara J. Deukmedjian, MD
Board Certified Neurosurgeon
Medically reviewed on: September 3, 2026
Disclaimer: The contents provided in this article are for informational purposes only and do not constitute medical advice. Consult a qualified healthcare professional for diagnosis and treatment specific to your condition.
Key Points
✓ 19% of in-network ACA marketplace claims were denied in 2024. The highest rate on record.¹
✓ MRI and CT denial rates reach 25–40% under Medicare Advantage.²
✓ 95% of physicians say prior authorization delays necessary care.³
✓ Delayed spine surgery increases complications, mortality, and readmission risk.⁴
✓ Spine MRIs face disproportionately high denial rates vs. other imaging.⁵
✓ Deuk Laser Disc Repair® offers a minimally invasive alternative with 99% pain relief rate, 0.01% complication rate, no hospital stay, and a free MRI review with no insurance approval required.
Introduction: A Broken System Is Keeping You From the Care You Need
Every year, health insurance companies deny hundreds of millions of claims for doctor-recommended treatments. That is not just a statistic. It is millions of real people are left without care for conditions like spine injuries, herniated discs, and chronic pain that worsens with every week of delay.
At Deuk Spine Institute, we see this happen to our patients far too often. Patients arrive in our office with debilitating pain after spending months. Sometimes years fighting their insurance company for an MRI or a surgical consultation that their doctor already deemed necessary.
This piece will provide you with the details about the insurance denials crisis, how spine patients are hit hard by it, what the health impacts of delayed care are and what you can do to become the master of your own destiny. The following facts have been verified by scientific research and governmental statistics.
How Many Health Insurance Claims Are Denied Each Year?
The scale of the problem is staggering. ACA marketplace insurers denied approximately 19% of in-network claims in plan year 2024. Roughly 8.8 million rejected claims out of 46 million submitted across HealthCare.gov states alone.¹ That 19% rate is tied with 2023 for the highest since the ACA marketplaces opened in 2015.¹
But that figure only covers the federal exchange. When you include employer-sponsored plans, Medicare Advantage, Medicaid managed care, and all other coverage types, the total number of denied claims across the U.S. health insurance system reaches into the hundreds of millions annually. A Thomson Reuters study previously estimated that the U.S. healthcare system wastes between $600 billion and $850 billion each year due to errors and inefficiency, with incorrect claims processing playing a central role.⁷
Nearly three in four healthcare providers surveyed by Experian Health said the number of claims denied by payers increased between 2022 and 2024, and 41% of revenue cycle leaders reported that at least one in ten claims is denied.⁸ ⁹
Why Are Spine Care Claims Denied So Often?
A claim denial occurs when your insurance company refuses to pay for a test, procedure, or treatment that your physician has determined is medically necessary. While denials affect all areas of medicine, spine care patients face particularly high barriers for two reasons: advanced imaging requirements and the cost of surgical intervention.
Spine MRIs Face Among the Highest Denial Rates
Magnetic resonance imaging (MRI) of the spine is the gold standard for diagnosing conditions such as herniated discs, spinal stenosis, and nerve compression. Yet it is also one of the most commonly denied imaging studies.
In a peer-reviewed study conducted in the Journal of the American Academy of Orthopedic Surgeons, it was established that spine MRIs were more often denied by prior authorization when compared to other MRIs in the body. Out of the total 17,913 MRIs prior authorization requests, 885 (4.94%) were directly denied and MRIs of spine were involved in an unfair share of the denial.⁵ Another study done at an academic spine center revealed that among the total MRI spine order requests, 85.56% were subjected to prior authorization, delaying patient diagnosis further.⁶
Under Medicare Advantage, the picture is even grimmer. Advanced imaging including MRI, CT, and PET scans face denial rates ranging from 25% to 40%.² Some individual insurers deny MRI requests at rates exceeding 30%.¹⁰
Common Reasons for Spine Care Denials
Insurance companies typically deny spine care claims for reasons such as:
- “Not medically necessary” — The insurer’s internal guidelines differ from your treating physician’s clinical judgment, even when clear symptoms such as radiculopathy or myelopathy are present.
- “Experimental or investigational” — Applied even to well-established, FDA-cleared procedures with years of published outcomes data.
- “Conservative treatment not exhausted” — The insurer requires a longer course of physical therapy, injections, or medication before approving the treatment your surgeon has recommended, regardless of clinical urgency.
- Missing or incomplete documentation — Administrative errors during the prior authorization process, which the 2024 Experian Health survey identified as one of the two leading drivers of denials alongside prior authorization failures.⁸
The Financial Incentive Behind Claim Denials
Understanding why insurance companies deny so many claims requires understanding their financial structure. Each month, insurers collect premiums anywhere from $500 to over $3,000 per family, depending on the plan. When they pay fewer claims, they retain more of that premium revenue.
The health insurance industry reported net earnings of $25 billion in 2023, according to the National Association of Insurance Commissioners (NAIC). That same year, the aggregate loss ratio. The percentage of premiums paid out as claims remained below 87%, meaning insurers retained roughly 13 cents of every premium dollar for administration, profit, and reserves.¹¹
When viewed through this lens, the denial of a $2,000 MRI or a $15,000 spine procedure is not a medical judgment. It is a business decision.
What Prior Authorization Does to Spine Patients: The Data
Prior authorization is the requirement that your physician obtain advance approval from the insurance company before a treatment or test qualifies for coverage. Is the single largest bureaucratic barrier between spine patients and the care they need.
The American Medical Association (AMA) has conducted annual nationwide surveys of practicing physicians to measure the impact of prior authorization on patient care. The findings are consistent and alarming:
- 95% of physicians say prior authorization delays access to necessary care.³
- 26% of physicians report that prior authorization has led to a serious adverse event for a patient in their care, including hospitalization, permanent impairment, or death.³
- 79% of physicians report that patients abandon treatment entirely due to authorization challenges.³
- 92% of physicians say prior authorization negatively affects clinical outcomes.³
- Physicians and their staff complete an average of 39 prior authorizations per week, spending approximately 13 hours on the process.¹²
For spine patients specifically, these delays can be catastrophic. A disc herniation compressing a nerve root does not pause while paperwork is processed. Spinal stenosis does not wait for an insurance reviewer to approve an MRI. Every week of delay is a week in which nerve damage may become permanent.
What Happens When Spine Treatment Is Delayed: Clinical Consequences
The consequences of delayed spine care are not abstract. Peer-reviewed research has quantified the harm:
Worse Surgical Outcomes
In a retrospective cohort study conducted in the U.S., 362,788 cases that underwent spine surgery from 2015 to 2020 were studied in the Global Spine Journal. Out of which 16,664 (4.59%) cases had surgical delay. This group of delayed patients showed higher rates of mortality, complication, length of stay in hospital, abnormal discharge, and re-admission than on-time surgery group.⁴
Irreversible Nerve Damage
Compressed spinal nerves can sustain permanent damage if the compression is not relieved in a timely manner. In the cervical spine, delayed decompression of the spinal cord in patients with myelopathy is associated with poorer neurological recovery and reduced functional independence.¹³
Increased Emergency Utilization
When patients cannot access elective spine care through normal channels, many are eventually forced into emergency departments with acute neurological decline. Mayo Clinic researchers have found that delays in spinal deformity surgery are associated with poorer overall patient outcomes.¹⁴
As AMA President Bruce A. Scott, MD, has stated, when patients face care delays or abandon necessary care, the result can be increased overall costs when worsening health conditions force patients to seek urgent or emergency treatment.³ ¹⁵
How Consumers Rarely Fight Back and Why That Matters
One of the most troubling findings from the KFF analysis is that consumers almost never appeal denied claims. Among the 8.8 million in-network claims denied across HealthCare.gov plans in 2024, the appeal rate was vanishingly low.¹
This is important because the scientific literature reveals that the overturning of many denials is common practice during the appeals process. An examination of denial of orthopedic imaging revealed that upon request for peer-to-peer review of the denied MRI and CT order requests, virtually all were eventually approved.¹⁶ In the case of the academic spine center study, 77.33% of the denied/cancelled spinal MRIs were done in three months following appeals or re-submission.⁶
The insurance denial system, in other words, works in part because patients do not know they can fight back or are too overwhelmed by pain and bureaucracy to try.
What You Can Do If Your Spine Care Has Been Denied
If your MRI, consultation, or spine treatment has been denied by your insurance company, you are not alone and you are not out of options.
Step 1: Request the Denial in Writing
Ask your insurer for a detailed written explanation of the denial, including the specific medical policy or guideline they are citing. You are legally entitled to this under the Affordable Care Act.
Step 2: Ask Your Doctor to Appeal
Many denials are overturned after a physician submits a peer-to-peer review request. The research cited above shows that the vast majority of MRI denials are approved once the treating physician speaks directly with the insurer’s reviewer.¹⁶
Step 3: File an External Appeal
If the internal appeal fails, you have the right under federal law to request an independent, external review. An outside physician will evaluate the case without any financial relationship to your insurance company.
Step 4: Get a Free MRI Review from Deuk Spine Institute
At Deuk Spine Institute, we offer a free MRI review by a board-certified neurosurgeon. No insurance approval required. If you already have an MRI, our team can evaluate your scan, identify the source of your pain, and discuss treatment options without waiting for insurer authorization.
Step 5: Contact Your Elected Officials
A systemwide solution will involve politics. Contact your representatives in both the state and national government and urge them to introduce legislation that will mandate evidence-based definitions of “medically necessary” and “experimental,” as well as prompt insurer action on prior authorization requests and independent review boards.
How Deuk Spine Institute Helps Patients Denied by Insurance
Deuk Spine Institute is the world leader in minimally invasive laser spine surgery. We have developed and refined proprietary procedures. Including Deuk Laser Disc Repair® (DLDR) specifically to provide patients with safer, faster, and more effective alternatives to traditional spine surgery.
As compared to spinal fusion surgery, laminectomy, and disc replacement surgeries, DLDR is done via a wound smaller than a quarter of an inch, with sedation, on an outpatient basis. The operation does not impact the structural stability of the spine and does not require hospitalization, general anesthesia, or opioids post-operation.
With over 2,800 procedures completed, a 99% pain relief rate for treated pain sources, and a 0.01% complication rate, DLDR represents what spine care can look like when the focus is on the patient; not the payer.
19% of claims denied. 95% of doctors say it delays care.
Your insurer said no.
Your spine can’t wait.
Delayed spine surgery raises complication rates, lengthens hospital stays, and increases readmission risk. A free MRI review from a board-certified neurosurgeon takes the insurance company out of the equation.
Medicare Advantage
treatment after denial
- Prior auth delays of weeks to months
- Spine MRIs denied at disproportionate rates
- Nerve damage can become permanent
- Appeals rarely filed by patients
- Free MRI review—no approval needed
- 99% pain relief rate
- 0.01% complication rate
- Same-day outpatient, no hospital stay
Board-certified neurosurgeon review · No insurance approval required · 100,000+ procedures performed
FAQ
Why do insurance companies deny spine surgery claims?
Denials from insurance companies on spine surgery claims are done for various reasons ranging from administrative to financial; but mostly because the surgery is not “medically necessary” or conservative measures like physiotherapy have not been tried. The 2025 survey of the American Medical Association shows that 95% of doctors think prior authorizations delay treatment.³ Mostly in such denials, what actually matters is cost-cutting by the insurance company.
How common are health insurance claim denials in the United States?
Claim denials are extremely common. The Kaiser Family Foundation found that ACA marketplace insurers denied 19% of in-network claims in 2024, which equates to roughly 8.8 million rejected claims across HealthCare.gov states alone.¹ Nearly three in four healthcare providers surveyed by Experian Health said denials increased between 2022 and 2024.⁸
Can I appeal a denied MRI or spine surgery claim?
Yes. Under the Affordable Care Act, you have the right to both an internal appeal with your insurer and an external review by an independent physician. Research shows that many spine MRI denials are overturned on appeal. One study found that 77.33% of initially denied spine MRIs were completed within three months after appeal or resubmission.⁶ Despite this, consumers rarely appeal denied claims, which is one reason insurers continue to deny at high rates.¹
What happens if I delay spine surgery?
Late spine surgery results in a greater risk for negative patient outcomes. A study conducted across the country involved 362,000 patients who underwent spine surgery. The findings indicated that those with delayed surgery were associated with higher mortality rates, high risks of developing complications, longer hospitalization period, and even readmissions.¹⁴ The compressed nerves require timely treatment in order not to suffer permanent damage.¹⁴
What is Deuk Laser Disc Repair® (DLDR)?
DLDR Deuk Laser Disc Repair® is a laser spine surgery procedure invented by Dr. Deukmedjian of Deuk Spine Institute. The procedure entails the removal of herniated discs through a puncture hole that is less than one-quarter inch in size under sedation at an outpatient surgery center. It does not use general anesthesia, no hospitalization or postoperative pain relievers and preserves the structure of the spine. Unlike spinal fusion and laminectomy procedures.
Sources
View Sources
- Kaiser Family Foundation. Claims Denials and Appeals in ACA Marketplace Plans in 2024. Published May 2026.
- 247 Medical Billing Services. Medicare Advantage Denials Rise With Prior Authorizations. Published April 2026.
- American Medical Association. AMA Survey: Prior Authorization Reform Pledge Falls Short with Physicians. Published May 2026.
- Zoghi S, et al. Predictive Factors and Impact of Delayed Spine Surgery: A Nationwide Retrospective Cohort. Global Spine Journal, 2026.
- JAAOS. Magnetic Resonance Imaging Prior Authorizations for Orthopaedic Care Are Negatively Affected by Medicaid Insurance Status. Journal of the AAOS, 2025.
- Kebaish KJ, Galivanche AR, Grauer JN. Is There Utility to Requiring Spine MRI Pre-authorizations? Clinical Spine Surgery, 2023.
- CareCloud. Health Insurance Claim Errors Waste $17 Billion Annually.
- Healthcare Dive. Providers Say Claims Denials Are Increasing: Survey. Published September 2024.
- Experian Health. Healthcare Claim Denial Statistics: State of Claims Report 2025.
- CareRoute. Prior Authorization Denied? How to Appeal and Win (2026 Guide).
- NAIC. U.S. Health Insurance Industry 2023 Annual Results.
- Texas Medical Association. Prior Authorization Fuels Physician Burnout, Decreases Access to Care, AMA Survey Finds. Published March 2025.
- Frontiers in Surgery. The Impact of Early vs. Delayed Surgery for Cervical Spinal Cord Injury. Published May 2026.
- Mayo Clinic. Delay in Adult Spinal Deformity Surgery Associated with Poorer Outcomes. Published April 2023.
- American Medical Association. AMA Survey Indicates Prior Authorization Wreaks Havoc on Patient Care. Published June 2024.
- Healio Orthopedics. Nearly All Peer-to-Peer Reviews for CT and MRI Prior Authorization Denials for Orthopedic Specialists Are Approved. 2023.
