Insurer takebacks rose 13.8% in the first half of 2026. Kodiak Solutions reported that takebacks, the money insurers claw back on claims already paid, equaled 1.57% of accounts receivable (A/R), up from 1.38% in the first half of 2025.
Kodiak compared the first six months of 2026 with the first six months of 2025 using claims from more than 2,300 hospitals and 375,000 physicians on its platform. Initial and final denial rates fell overall in that period. Cash flow did not improve with them.
Takebacks and recoveries moved in opposite directions
Kodiak measured two post-payment flows as a share of A/R. Takebacks are payments an insurer reverses after paying. Recoveries are money providers win back after a claim was paid. Takebacks grew 13.8%, and recoveries shrank 12.2%, from 2.48% to 2.21% of A/R.
| Measure (share of A/R) | H1 2025 | H1 2026 | Change |
|---|---|---|---|
| Takebacks | 1.38% | 1.57% | +13.8% |
| Recoveries after payment | 2.48% | 2.21% | -12.2% |
| Recoveries minus takebacks (points of A/R) | 1.10 | 0.64 | -0.46 points |
Source: Kodiak Solutions, September 15, 2026 analysis. The last row is subtraction of the two rows above it.
The gap between what providers win back and what insurers take back narrowed from 1.10 points of A/R to 0.64 points. A smaller gap means less net cash from post-payment activity, even when fewer claims are denied up front. On $1,000,000 in A/R, the 0.19-point rise in takebacks equals $1,900.
Commercial claims, Medicare Advantage, and the 2025 base
Kodiak found that the commercial final denial rate rose 9.1%, to 2.89% of A/R, in the first half of 2026. Commercial takebacks rose 12.0%, to 2.25% of A/R. The overall denial rate fell, so the commercial book moved against the trend.
Kodiak also reported that insurers operating Medicare Advantage plans had more than double the percentage of takebacks of traditional Medicare. A practice with a high Medicare Advantage share will see a larger takeback line than a practice with a low share.
At the 2.25% commercial rate, a group holding $2,000,000 in commercial A/R would see $45,000 reversed after payment. At the 1.57% overall rate, the same base gives $31,400.
Kodiak's March 31, 2026 benchmarking analysis covered more than 2,300 hospitals. It put net revenue lost at $48 billion in 2025, up 25.0% from $38.6 billion in 2024. The final denial rate rose to 2.7% from 2.5%, and the bad debt rate rose to 1.3% from 1.1%.
Kodiak said clinical denials, which cover missing precertification or prior authorization and medical necessity, accounted for virtually all of the increase in denial rates. These are hospital figures. Kodiak did not break out physician practices in that release.
What appeal and denial data show about winning money back
KFF analyzed 2024 claims in ACA marketplace plans, and published the results on March 24, 2026. Insurers denied 19.0% of about 451 million in-network claims, roughly 85 million claims. Marketplace enrollees filed at least 5,881 external appeals, equal to 4.0% of upheld internal appeals. Fewer than 1.0% of denied claims were appealed, and insurers upheld 66.0% of the appeals that were filed.
A JAMA study of about 51,000 New York external appeal cases, reported by Healthcare Dive on April 15, 2026, found a different pattern at the external review stage. The overturn rate rose from 38.0% in 2019 to almost 53.0% in 2025. Overturn rates for denied home healthcare services were above 78.0%, and prescription drug and dental denials were overturned more than 50.0% of the time.
The three datasets cover different populations: a marketplace dataset, a state external review program, and a provider platform. They do not combine into one national rate. Each shows money that sits in a dispute process, and each shows that outcomes depend on whether a case is pursued.
KFF also reported the reasons behind in-network denials. Of about 496 million total claims received, 451 million were for in-network services. The denial rate for out-of-network claims was 37.0%.
| Reported reason for in-network denial | Share of denied claims |
|---|---|
| Other (reason not specified) | 36.0% |
| Administrative reasons | 25.0% |
| Excluded services | 13.0% |
| No prior authorization or referral | 9.0% |
| Medical necessity | 5.0% |
Source: KFF, March 24, 2026, ACA marketplace plans, 2024 claims.
Administrative reasons made up 25.0% of denials, five times the 5.0% share for medical necessity. Administrative denials come from registration, eligibility, and coding data that a practice controls at the front end. Kodiak's finding that clinical denials drove the 2025 hospital increase shows the mix differs by setting.
Where a practice can measure this
MGMA Stat polled medical group leaders on July 28, 2026, and received 203 applicable responses. Of those, 48.0% named denials and appeals as the largest source of revenue leakage, against 23.0% who named front-end issues. MGMA benchmarking puts first-submission denials at 7.0% to 8.0% across the past four years, and MGMA says targeted process fixes can push the rate below 5.0%.
At a first-submission denial rate of 7.0% to 8.0%, every 100 claims produce 7 to 8 denials. Below 5.0%, they produce fewer than 5. Denial reports do not capture takebacks. A takeback appears as a negative adjustment on a claim that was already posted as paid. To see it, a billing team can pull post-payment adjustments by payer and by month and divide them by A/R. Kodiak's 1.57% overall figure and 2.25% commercial figure give two reference points.
In the same MGMA poll, 32.0% of leaders said days in A/R were higher than a year earlier, 22.0% said they were lower, and 43.0% said they were about the same.
Sources
- Kodiak Solutions via 01net.it, Falling rates of insurance claim denials fail to drive better financial performance, September 15, 2026
- Kodiak Solutions via Bastille Post, Healthcare provider organizations saw net revenue losses grow in 2025, March 31, 2026
- KFF, Claims Denials and Appeals in ACA Marketplace Plans in 2024, March 24, 2026
- Healthcare Dive, More insurance claims denials are being overturned upon appeal, study finds, April 15, 2026
- MGMA Stat, Days in A/R holds steady for most practices, but payer pressure persists in 2026, July 30, 2026
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