This woman had countless health insurance claims denied for her caudal regression syndrome — but now there's 1 cheat code to file appeals. Can it work?

Are insurance companies harnessing AI?

Lee noted her claim denials now appear to happen at a faster speed, which she suspected was due to the use of artificial intelligence (AI).

“It’s like an automatic rejection of your appeal now,” she said.

TNM says it reached out to Cigna, Humana and UnitedHealth Group for comment. UnitedHealth stated that “claims that we use an AI algorithm to automatically deny claims are false.” Cigna stated that “we do not use AI to deny care or claims.” Humana did not respond.

But not everyone believes such claims from health insurance companies. Ryan Clarkson, founder and managing partner of Clarkson Law Firm, told TNM his firm has three major class-action cases proceeding against large health insurance companies for allegedly using AI and algorithms in place of licensed physicians in the claims process.

According to Clarkson, the insurer in one of those cases denied about 300,000 claims over a two-month period. During that time, he said it was calculated the company would have had about 1.2 seconds to review each claim, “and no reasonable person could ever conclude that 1.2 seconds is sufficient time to evaluate a medical insurance claim.”

The idea of using AI for processing claim denials isn’t new. In March 2023, STAT reported that AI was “driving denials to new heights in Medicare Advantage, the taxpayer-funded alternative to traditional Medicare that covers more than 31 million people.”

Concern around this topic was enough for the Centers for Medicare & Medical Services to send a memo in February 2024 to Medicare Advantage insurers clarifying that AI can’t be used this way, according to Ars Technica. Additionally, multiple states are looking at ways to regulate the use of AI in health insurance.

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Patients can use the power of AI

In the meantime, some patients are taking it upon themselves to fight against claim denials. And they’re using AI to do it.

Holden Karau is the co-founder of Fight Health Insurance, a website that helps Americans appeal health insurance claims. That includes using AI to help generate health insurance appeals. Patients can upload their claim denial and in return receive a targeted appeal.

Karau built the tool after facing her own struggles with health insurance companies. At the time she spoke with TNM, she said the site had been used 3,546 times, and she had seen denials ranging from a few hundred dollars to what she estimated could be hundreds of thousands of dollars.

Karau told The San Francisco Standard that, while she doesn’t think health insurance companies will stop denying the big things, maybe making appeals more accessible will stop them from denying so many small things.

As Lee pointed out in her interview with TNM, why shouldn’t the average person fight fire with fire?

“If they’re doing it, we should also have that tool.”