AI for denied claims
- Bloomberg profiled Claimable, a startup using AI to help Americans dispute denied health-care claims. - The story highlights investors backing and interest from figures like Mark Cuban in the space. - The example underscores that document-heavy healthcare workflows are attractive, measurable targets for applied AI products (bloomberg.com).
A startup called Claimable is using artificial intelligence to write health-insurance appeals for patients whose care was denied. (bloomberg.com) Claimable’s site says patients upload a denial notice and insurance information, answer questions, and get an appeal package built from their medical story, clinical evidence, and policy details. The company says it is available nationwide and works with denials from private insurers as well as Medicare and Medicaid plans. (getclaimable.com 1) (getclaimable.com 2) The company says more than 4,000 patients have used the platform, more than 80% of its appeals succeed, and most decisions come back within 10 days or less. Bloomberg reported interest and backing in the category from investors and from Mark Cuban, who has become one of the best-known names attached to the effort. (bloomberg.com) (getclaimable.com) The pitch lands in a market where denials are common and appeals are rare. KFF reported on March 24 that insurers selling qualified health plans on HealthCare.gov denied 19% of in-network claims in 2024, while fewer than 1% of denied claims were appealed. (kff.org) KFF also found that insurers upheld 66% of internal appeals in 2024, and enrollees filed at least 5,881 external appeals after those internal reviews. The same report said the most common reported reason for in-network denials was an unspecified “other” category at 36%, followed by administrative reasons at 25%. (kff.org) A 2024 Commonwealth Fund survey found 17% of insured working-age adults were denied coverage for a doctor-recommended service. Among people who faced billing errors or coverage denials, fewer than half challenged them, mostly because they did not know they had that right. (commonwealthfund.org) That helps explain why startups are targeting paperwork-heavy parts of health care first. An appeal is a bounded task: collect records, match them to insurer rules, cite evidence, and produce a letter that can be judged by a concrete outcome — approved or denied. (bloomberg.com) (kff.org) Patients already have formal appeal rights under federal rules. The Centers for Medicare & Medicaid Services says consumers can first seek an internal review from their plan and then ask for an outside, independent review if the insurer upholds the denial. (cms.gov) HealthCare.gov says standard external reviews must be decided within 45 days, and urgent cases can be decided within 72 hours. For companies like Claimable, the bet is that better paperwork and faster filing can get more patients into that process before treatment delays turn into missed care. (healthcare.gov)
