Doctors Use AI To Appeal Insurance Denials

Doctors are using AI to automate appeals against insurance denials.

Frustrated by a healthcare system that routinely denies treatment, some U.S. doctors are turning to AI to push back. The San Francisco Standard (SFS) reports on a new tool, called Fight Paperwork, which enables medical practitioners to produce appeal letters for insurance claim rejections, which both saves administrative time and enhances the probability of successful approval.

Dr. Paul Abramson, who practices medicine in San Francisco, said to SFS that insurers often communicate through email and fax to deny necessary treatments, hoping that  doctors and patients will abandon their appeals. The system relies on patient and doctor frustration as its primary strategy. But when doctors do appeal, they’re successful in most cases. The problem is that less than 1% of denials are ever appealed, as noted by SFS.

“There are no consequences to the insurance companies for wasting everyone’s time,” Abramson told SFS. “When there are more consequences, they will stop playing the game,” he added.

That’s where AI comes in. Fight Paperwork, which was developed by former Netflix engineer Holden Karau, helps automate the appeal process. The platform has generated more than 6,000 appeals since its launch in May, which has reduced both expenses and administrative time spent on bureaucratic procedures. Mental health providers, who often work alone, make up the largest number of users for this tool, as reported by SFS.

Still, some experts believe the playing field is far from even. “I think an ‘arms race’ is optimistic, because it would imply that there are equal sides. It’s more of a mosquito bite that may cause them some inconvenience […] their robot basically wrestles with your robot.” said retired Bay Area doctor Harley Schultz, as reported by SFS.

While AI offers hope, many doctors stress that real change must come through regulation. California is considering laws to increase transparency from pharmacy benefit managers, a key player blamed for rising costs.

Until then, AI is offering doctors like Abramson a small, but powerful, way to reclaim their time and fight for their patients.