AI startup helps patients overturn insurance denials

AI-powered startup aims to empower patients in insurance battles: Claimable, a new AI-driven platform, launches to help patients challenge insurance denials and streamline access to necessary treatments.

• Claimable, founded by physician-executive Warris Bokhari, utilizes large language models like GPT-4 to generate compelling appeals letters for patients facing insurance denials.
• The startup focuses initially on rheumatology clinics, addressing challenges faced by patients requiring expensive biologic drugs for conditions like arthritis.
• Claimable’s AI system is fine-tuned with up-to-date clinical guidelines, FDA labels, and trial data to create accurate and persuasive appeals.

The technology behind Claimable: The platform leverages advanced AI capabilities to transform patient stories into compelling arguments for insurance companies.

• GPT-4 is used to summarize patient information at various reading levels, making complex medical data more accessible.
• The AI system is trained on the latest guidelines from the American College of Rheumatology and other relevant medical information.
• Claimable generates appeal letters for a flat fee of $39.95, aiming to make the service affordable and accessible to patients.

Early results and future plans: Initial pilot testing shows promising outcomes for patients using Claimable’s services.

• The fully-automated software pilot phase has generated around 50 appeal letters with an 80% denial overturn rate.
• Most cases have been resolved in under 10 days, significantly reducing waiting times for patients.
• Claimable plans to expand its services to cover more than a hundred conditions by 2025, including multiple sclerosis, cardiac diseases, diabetes, obesity, asthma, and certain cancers.

The broader context: Claimable’s launch comes at a time when the healthcare industry is grappling with the implications of AI in administrative processes.

• Industry experts predict a potential “battle of the bots” between healthcare providers and insurers over care decisions.
• Patients often find themselves caught in the middle of these disputes, facing delays in accessing necessary treatments.
• Claimable aims to shift the balance by putting AI tools directly in the hands of patients, empowering them to advocate for their own care.

Personal motivation and industry insights: Founder Warris Bokhari’s background and experiences shape Claimable’s mission and approach.

• Bokhari’s mother suffered from rheumatoid arthritis, providing personal insight into the challenges faced by patients with chronic conditions.
• His experience growing up in England, where his family didn’t face financial ruin due to medical expenses, informs his perspective on healthcare access.
• Through the development process, Bokhari discovered that many insurance denials stem from outdated disease guidelines, highlighting a systemic issue in the industry.

Funding and growth: Claimable secures initial funding to support its development and expansion plans.

• The startup has raised a seed round led by Walkabout Ventures, though the exact amount remains undisclosed.
• This funding will support Claimable’s ambitious plans to expand its services across a wide range of medical conditions in the coming years.

Potential impact on healthcare administration: Claimable’s approach could have far-reaching implications for how patients interact with the healthcare system.

• By automating and streamlining the appeals process, Claimable may reduce administrative burdens on both patients and healthcare providers.
• The platform’s success could prompt insurance companies to reassess their denial processes and update their guidelines more frequently.
• As AI continues to play a larger role in healthcare administration, tools like Claimable may become increasingly important in ensuring patient advocacy and access to care.

Looking ahead: Challenges and opportunities: While Claimable shows promise, its growth and impact will depend on various factors.

• The startup will need to navigate complex regulatory landscapes as it expands to cover more medical conditions and potentially enters new markets.
• As AI technology evolves, Claimable may need to continuously update and refine its algorithms to maintain accuracy and effectiveness.
• The success of Claimable could inspire similar AI-driven solutions in other areas of healthcare administration, potentially leading to broader systemic changes in how patients interact with insurers and healthcare providers.