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 wife’s 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, it’s 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 don’t know they can appeal, or don’t know on what grounds they can appeal.
In fact, according to Shah’s research, 850 million claims denials occur every year, and less than 1% are ever appealed.
That’s where Counterforce Health comes in, a startup that’s created a free-to-use app for claims denials.
It’s 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.
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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, they’ve built Counterforce to the point where it boasts a 70% success rate in appealing claims.
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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 it’s really about to click,” Shah said.
WATCH the story below from ABC 11…
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