What denial recovery services actually cost
Pricing in this industry is opaque on purpose. Here's an honest map of what the options typically cost a small practice, the hidden fees to ask about, and where our own published pricing sits — so you can compare with real numbers.
The four ways practices pay to get denials worked
| Model | Typical pricing | What you're really buying |
|---|---|---|
| Hospital-tier contingency recovery vendors | Hospital-tier recovery vendors commonly charge in the range of 20–35% contingency on recoveries; firms specializing in aged/old AR often quote at the high end or above it. | Project teams and enterprise tooling. Built for health-system denial inventories; most won't engage a small practice at all. |
| Full billing-company takeover | Outsourced billing services are typically quoted as a percentage of total collections — industry guides commonly cite ranges around 4–9%, varying with specialty and volume. | Your entire billing operation, not just denials. The percentage applies to all collections — including the clean claims that would have paid anyway — usually with a contract term. |
| Denial software (SaaS) | A subscription regardless of results, plus setup/integration effort. | Analytics and worklists. Your staff still does the actual appealing — the software pays off only if you have hours to sit in it. |
| Hourly consultants / temp billers | Hourly rates, paid whether or not anything is recovered. | Hands, without aligned incentives — you carry all the outcome risk. |
Ranges above are hedged industry-typical figures, not quotes from any specific vendor — always confirm a vendor's actual rate and contract terms in writing.
The hidden fees to ask about before signing anything
The quoted percentage is rarely the whole price. Before signing with any billing or recovery vendor — us included — get written answers on:
- Setup, onboarding, or "implementation" charges layered on top of the percentage.
- Monthly minimums that turn a contingency deal into a subscription in slow months.
- Termination fees and auto-renewing terms — the loudest complaint small practices report about billing vendors is not the rate, it's the contract they couldn't leave.
- What the fee applies to. Recovered dollars that actually posted? Billed amounts? Estimated value? This single definition changes the real cost more than the headline rate does.
- Statement and reporting fees, per-claim charges, clearinghouse pass-throughs.
Why contingency beats hourly for a small practice
A denied claim is an uncertain asset: more than half of appealed denials are overturned industry-wide (Premier Inc. payer-denials analysis), but any individual appeal can lose. Hourly pricing puts that uncertainty on you — you pay for the losing appeals too. Contingency pricing puts it on the vendor: if nothing posts, nothing is owed, and the vendor is forced to do the triage a practice would want anyway, working only claims genuinely worth working. For a practice where industry estimates put per-claim rework at roughly $25 of internal cost, contingency is the only model where trying costs you nothing when it fails.
The one caution: contingency only stays honest when the fee is tied to money that actually posts to your accounts, verified against your own remittances. If a vendor invoices on estimates or "identified value," walk.
Where Claimmender's pricing sits — published, no quote call
Nothing upfront. Nothing monthly. Nothing if we recover nothing.
Our fee is 25% of recovered dollars that actually post to your accounts — verified against your own remittance data, invoiced monthly, disputable line by line. Founder-led means we can only run twelve practices well — the first twelve pay 20% permanently in exchange for being reference-able. No setup fees, no minimums, no term commitment. The denial scorecard that starts everything is free either way and yours to keep. Scope note: we work commercial-payer claims only; Medicare and Medicaid are excluded.
Yes, 25% is a bigger number than a billing company's 4–9% — because it applies to a completely different base. A billing percentage applies to everything you collect, including the clean claims that needed no help. A recovery contingency applies only to denied dollars that would otherwise have been written off — money that, without the work, would have been zero.
Run the comparison on your own numbers
The honest way to compare any of this is against your actual denial file, not industry averages. Send six months of the 835/ERA remittance files your billing software already produces — within one business day you get a free denial scorecard: total denied dollars, what's realistically recoverable and why, and what isn't worth chasing. Then every vendor conversation, including ours, happens with real numbers on the table.
Send 6 months of remittance files — get a free denial scorecard of your denied dollars, what's recoverable, and your top payer patterns, within one business day. Contingency-only: no fee unless money posts.
Get your free denial scorecardMore guides: denial management for small practices · hospital vendors vs. small-practice recovery · the denial code library.