Dealing with Insurance Is Game Theory

Business is poker. You never have all the information, but you still have to make decisions.

When my partner and I started playing poker during work breaks, the parallels between negotiations with payers and poker became impossible to ignore. It became a model for how we think about strategy, risk, and decision-making under uncertainty.

In poker, even pocket aces, the best starting hand, don't guarantee a win. You can lose any single hand to bad luck. But because their expected value (EV) is so high, the rational move is always to play them. Over hundreds or thousands of hands, the player who consistently makes +EV decisions ends up ahead.

The Same Dynamics in Healthcare Reimbursement

At MedRes, we see the same dynamics every day in healthcare reimbursement. Physicians and RCM companies are constantly making decisions with incomplete information:

Each of these moments mirrors a poker decision: imperfect information, asymmetric risk, and a need for clear, probabilistic thinking.

Expected Value in the Real World

When fighting enough disputes, over time, luck stops mattering. The variance evens out, and the math wins.

Across hundreds of disputes, we've found that our data-driven approach delivers consistent results:

These results are the outcome of systematically choosing the higher-EV path in every case.

How Game Theory Improves Outcomes

Game theory teaches that rational players don't chase wins, they optimize for expected outcomes over time. The same holds true in dealing with insurance.

Payers often rely on information asymmetry and provider fatigue to minimize payouts. But by bringing data, process automation, and legal expertise to the table, we shift that balance. Our platform evaluates disputes based on CPT code value, documentation strength, payer behavior, and precedent all before a case is filed.

That means fewer wasted "hands", fewer emotional bets, and more strategic wins.

Playing the Long Game

Physicians often view payer interactions as zero-sum battles, but the truth is closer to a repeated game. Every claim, appeal, and IDR submission is another iteration in which patterns, incentives, and probabilities start to reveal themselves.

When viewed through that lens, success becomes predictable. Just as professional poker players don't fear short-term losses, providers who understand the expected value of fair reimbursement stop worrying about the randomness of individual payer decisions.

With enough volume and the right methodology, math beats luck.

The Takeaway

The next time you're staring at a denial or an underpayment, ask yourself: What's the expected value of playing this hand?

At MedRes, that's how we think about every case we file. We know not every dispute will hit, but over hundreds of filings, our strategy wins and wins big.

So maybe the next time you're off the clock, grab a deck of cards. Poker won't just sharpen your game it might just help you rethink how you deal with payers.