You delivered care. You submitted the claim. And now you wait.
30 days. 60 days. Sometimes longer. If you run a practice, you already know this. You’ve been living it. But I think it’s worth breaking down WHY it takes so long, because once you see how many layers of delay are stacked on top of each other, it starts to make sense why optimizing your billing process only gets you so far.
The claim doesn’t go straight to a check
When your team submits a claim, it doesn’t just land on someone’s desk at Aetna. It goes through your PM system, gets scrubbed by a clearinghouse for errors, and then gets forwarded to the payer. Even if everything is coded perfectly, that’s 1 to 3 days before the insurance company even sees it.
Then they start adjudication. Eligibility verification, coverage confirmation, medical necessity review, coordination of benefits, contracted rate application. For clean claims with zero issues, most states require payers to pay within 30 to 45 days. That’s the best case scenario. And when does the best case actually happen?
The second anything triggers a request for additional documentation or a pre-auth review, the clock resets. If the claim gets denied, you’re looking at another 30 to 60 days just for the first appeal response. And if that appeal gets denied? Start over.
Denials make everything worse
Denial rates keep climbing. Some specialties like radiology and cardiology are seeing rates above 15%, and even across the board, initial denial rates hit 11.8% in 2024, up from 10.2% a few years prior. Missing prior auth, coding errors, timely filing, medical necessity disputes. You know the list.
Every denial creates a whole new cycle of work. Find the root cause, pull the documentation, submit the appeal, wait. A lot of practices don’t have a dedicated team to work denials, so those claims just get written off. That revenue you earned disappears.
Government payers are their own thing
Medicare is actually not terrible on clean electronic claims. Usually 14 to 30 days. But the second there’s a hiccup, you’re in a longer review cycle. Medicaid is a different story entirely and it varies wildly by state. Some state programs take 60 to 90 days. Then throw in government shutdowns, sequestration, and policy changes and it gets even less predictable.
If your practice has a heavy Medicare or Medicaid payer mix (rural hospitals, FQHCs, community health centers, behavioral health providers), this isn’t something you can optimize your way out of. It’s just how the system works.
Nobody talks about the internal lag
There’s also a gap between when care happens and when the claim even gets submitted. Plenty of practices batch claims weekly. Some specialties need documentation finalized before they can bill. Organizations that bill at the end of the month might not submit a claim for three to four weeks after the patient was seen.
So the payer’s 30 to 45 day clock doesn’t even start until the claim is in the system. Add it up and you’re looking at 60, 75, 90+ days from the date of service to actual payment.
What this looks like in real numbers
A practice billing $500K a month with 60 days in AR has $1 million sitting out there that they can’t touch. That’s $1 million that can’t go toward payroll, equipment, hiring, patient programs, or growth. So you take on a line of credit, or you push back purchases, or you just run lean and hope nothing unexpected comes up.
Most practices are doing some version of this right now.
So what can you actually do?
The traditional options aren’t great. You either wait it out, or you take on debt.
There’s a newer approach. Claim advance platforms let you access up to 80% of your expected claim value the same day you submit. When the payer reimburses, the advance gets collected plus a flat fee, and the remaining balance goes to you. If a claim is denied, the platform absorbs the loss. No changes to your billing workflow.
That’s what we built at Thrivory. If you’re curious what this would look like for your specific practice, you can get started here.
