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These Entrepreneurs Are Using AI To Fight Health Insurance Claims Denials

Dec 11, 2024 - forbes.com
The article discusses the growing use of AI by health insurers like UnitedHealthcare to approve or deny claims, leading to a high rate of denials and sparking a national conversation following the murder of its CEO, Brian Thompson. Entrepreneurs like Holden Karau and Warris Bokhari are developing AI-driven tools to help patients appeal these denials. Karau's FightHealthInsurance.com offers pre-written appeals to challenge denials, while Bokhari's startup, Claimable, focuses on assisting patients with conditions like rheumatology and migraines. Claimable charges a flat fee and has a success rate of over 85% in appeals. The article highlights the disparity between the high rate of denials and the low rate of appeals, emphasizing the need for regulatory changes to support patients.

The article also touches on the personal motivations behind these tools, with Karau's experiences of fighting for insurance coverage for gender-affirming surgery and physical therapy inspiring her project. Bokhari, a former executive at major companies, aims to use AI to create compelling stories for insurers to approve payments. Both entrepreneurs believe that while AI won't fix the health insurance system, it can make it more accessible. The article concludes with concerns about potential increases in denials under the incoming Trump administration, particularly affecting Medicare and veterans.

Key takeaways:

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  • UnitedHealthcare has one of the highest rates of claims denials, often using AI to deny patient care, which has sparked national attention and legal challenges.
  • Entrepreneurs like Holden Karau and companies like Claimable are developing AI-driven tools to help patients appeal insurance denials, aiming to level the playing field against insurers' use of AI.
  • Claimable, co-founded by Warris Bokhari, charges a flat fee to help patients appeal denials, boasting a success rate of over 85% and plans to expand its services to cover more conditions.
  • There is concern that insurance denials may increase under the incoming Trump administration, potentially impacting Medicare and veterans' healthcare.
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