Current Events > Insurance Companies use AI to quickly deny claims, new AI app quickly appeals

(+) Yeah! (+)

The idea that American health insurance companies are using AI to analyze and adjudicate claims for approval or denial sounds terrifying, but one North Carolinian is using AI to fight back.

When Raleigh resident Neal Shah had a claim denied for his wifes chemotherapy drugs, he thought it was rare, that he was the only one, that it was just bad luck.

Litigating his case on phone calls that lasted for hours changed the husband and father, and he set about creating a sophisticated app that uses artificial intelligence to compare claims denial forms against health insurance contracts, before automatically drafting an appeal letter.

For a doctor to write this, its not rocket science, but it still takes hours, Shah told ABC News 11, adding that a well-written appeal letter, sent in immediately, can sometimes get denials reversed within days or weeks, but most people either dont know they can appeal, or dont know on what grounds they can appeal.

In fact, according to Shahs research, 850 million claims denials occur every year, and less than 1% are ever appealed.

Thats where Counterforce Health comes in, a startup thats created a free-to-use app for claims denials.

Its all the more critical a service now that health insurance companies, already armed with statewide government-protected pseudo monopolies and duopolies, are using AI to deny claims within seconds of them being filed.

Before, you used to have a reason you would deny it, and you used to have a doctor review or a nurse review it, but once AI rolled out, they could just have AI deny it, Shah explained.

For Counterforce Health, Shah brought onboard Riyaa Jadhav, a Jill of all trades who has helped grow and expand the undertaking through her experience in both the business world and working alongside patients at Johns Hopkins University Hospital.

Together, theyve built Counterforce to the point where it boasts a 70% success rate in appealing claims.

Thousands have already logged on; many going on to use the service.

Sometimes when enough people get loud, enough people put pressure, then I think all of a sudden society wakes up, so I really feel like its really about to click, Shah said.

https://www.goodnewsnetwork.org/big-insurance-uses-ai-to-quickly-deny-claims-physican-fights-back-with-ai-app-that-quickly-appeals/

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The AI arms race has begun

We have to pay out the nose for health insurance, only to get denied the actual service we paid for. Fact we have to counter corporate abuse of AI with homegrown AI would be ridiculous in any other country.

Fuck America.

chaos_knight posted...

We have to pay out the nose for health insurance, only to get denied the actual service we paid for. Fact we have to counter corporate abuse of AI with homegrown AI would be ridiculous in any other country.

Fuck America.

health insurance is obviously the most important, but insurance in general has been a fucking nightmare.

whether its medical, car or home. These companies dont want to pay out.

and at the same time, I understand there was and is a lot of fraud. But when they are still denying medical claims that have been approved by doctors as medically necessary, shit gotta change.

There's a lot of insurances out there that don't pay for shit outside of your annual visit.

jefffan posted...

There's a lot of insurances out there that don't pay for shit outside of your annual visit.

I mean it's not surprising. By nature, corporations desire routine predictability. The inevitable random failings of the aging human body are just beyond undesirable. The sensible thing would be to just not initiate such a business that comes with such unpredictability, but the money is just so good when you're only collecting it.

Insurance is one of the only services where the explicit goal of the provider is to not give you the service that you've paid for.

More bot civil wars

lol

https://youtu.be/8_c0xA7Qtv0?si=ThT3-PIUfeeHcLO-

UnfairRepresent posted...

In fact, according to Shahs research, 850 million claims denials occur every year, and less than 1% are ever appealed.

Yeah, that's their incentive: wear people down and retain fat stacks of cash.

So until/unless the system changes, I'll gladly accept an AI version of Mr. Incredible helping people to find every loophole and exploit every weakness of the insurance companies hoping to cover nothing. :P

In a just world these insurance companies would face serious consequences for denying these claims.

Thank you. I will share this.

Begun, the AI wars have.

Does Luigi know about this?

I used the stones to destroy the stones ass timeline

legendary_zell posted...

I used the stones to destroy the stones ass timeline

"I used the stones to steal art"

DuneMan posted...

Yeah, that's their incentive: wear people down and retain fat stacks of cash.

So until/unless the system changes, I'll gladly accept an AI version of Mr. Incredible helping people to find every loophole and exploit every weakness of the insurance companies hoping to cover nothing. :P

They have figured out that one easy way to make money is to hide the information, make it incredibly difficult to access, or, barring all else, insert it into a massive 30+ page document so that youll miss it.

There are entire people in both the healthcare industry and the insurance industry whose explicit career purpose is to try and fuck over as many customers as possible.

One of the main priorities of companies seems to be replacing as many employees as they can with worthless AI as they raise their prices, increasing wealth inequality. These insurance companies need to be leashed.