A new class of contenders is entering the AI arms race between payers and health systems.
Several AI startups are now using large language models to fight insurance denials on behalf of patients with early results that are turning heads.
Claimable — founded by British physician and entrepreneur Warris Bokhari, MD, in 2023 — uses an AI model trained on insurance law, medical literature and legal precedents to generate and file appeal letters on behalf of patients. For $50, users submit their case details on the company’s website. Claimable sends the resulting letter to the insurer’s appeals department and, in some cases, to executives, politicians and journalists to add pressure, Bloomberg reported April 22.
About 4,000 patients have used the platform, with about 3 in 4 seeing their denials reversed. In one case, a denial was overturned within a day after Claimable escalated it to the patient’s senator, governor, the insurer’s CEO and investor Mark Cuban, who emailed the employer’s CEO and posted publicly about the situation on LinkedIn.
Claimable is also moving beyond the direct-to-consumer model. The company has signed deals with four drugmakers and is negotiating with health systems to handle appeals on behalf of their patients who have had treatments denied. In addition, the company is exploring a litigation arm to pursue class-action lawsuits when it identifies patterns of allegedly wrongful denials across payers.
Sheer Health, another startup, takes a broader approach, handling the entire appeals process on behalf of patients for $40 a month or a percentage of money recovered, according to CBS News. Users submit their bill via photo upload and the company manages all insurer communication and paperwork.
“Our goal is for people to never have to deal with their health insurance again,” co-founder Ben Howard told the publication.
The startups are entering a market shaped by years of escalating friction between payers and hospital revenue cycle teams over claims and prior authorization. AI is accelerating that dynamic on both sides. As automation makes it faster and easier to deny claims, it is also making it faster and easier to fight them.
Whether patient-facing tools like Claimable and Sheer Health can meaningfully shift that balance remains to be seen, but the gap they are targeting is real. Claimable estimates insurers deny 850 million claims annually, extrapolated from federal data, though the company did not disclose which dataset or how the figure was calculated. Consumers appealed fewer than 1% of denied claims in 2023, and when they did, insurers upheld their original decision 56% of the time, KFF data shows.
Lawmakers are also starting to take notice. Arizona passed a law that takes effect this June requiring licensed medical providers to have the final say on coverage denials, and Louisiana is advancing similar legislation that would require human clinical review before any denial is issued.
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