What are denials
actually costing you?
Roughly one in seven behavioral health claims is denied, usually for the things a proper verification catches first. Put your own numbers in and see the figure for your practice.
Adjust assumptions
Illustrative estimate for discussion, not a quote or guarantee. Behavioral-health denial rates commonly run 10–15%+; this tool defaults to a conservative share, and figures vary by payer mix, fee schedule, and denial history.
Where the money actually goes.
The calculator multiplies your session volume by your average reimbursement, then by the share of claims that fail for reasons a verification would have caught before the visit. Four things drive almost all of it.
Coverage that ended
A plan terminated at the end of last month, or a patient moved to a new employer. The session happens, the claim comes back with no active coverage, and the balance lands on the patient weeks later.
The carve-out
The card says one payer, but behavioral health is administered by another entirely, Optum, Carelon, Evernorth, Magellan. Billing the medical plan gets a denial every time, and it is the single most common failure in this specialty.
Authorization or referral
Some plans require prior authorization for a routine outpatient hour, or a PCP referral on file first. Nothing about the visit looks unusual, and the claim is denied on a technicality.
Out-of-network status
The practice is contracted with the payer but not with that specific plan or product line. The patient is quoted a copay that turns out to be a deductible, and collection gets very hard.
Read the longer version: why behavioral health claims get denied and what a carve-out actually is.
Verification,
fully handled.
Every session verified before it happens. Carve-outs caught, claims paid, your team free. Let's get you live.