How to Use AI to Fight and Win Your Health Insurance Denials

New tools can analyze your medical bills for errors and use data from your phone to draft powerful appeal letters, leveling the playing field against giant insurers.

AI is going to be used in ways we have not thought of, perhaps the likes of Musk have, but for us simpletons, it’s hard to see all the ways AI will be used to enrich our lives outside of the obvious “Rosie” from the Jetsons, etc.

Though, now another industry looks like it will be changing for the better with its utilization of artificial intelligence—the insurance industry! We are now seeing free-market innovations coming in to solve real-world problems, ironically, with the help of AI. Most recently, patients are using AI tools to fight insurance denials, utilizing data-driven arguments in their quest to have the insurance companies pay their previously denied claims.

With platforms like Google's Health Connect, you can manage and control your own health data directly on your Android device, collected from your wearable health devices. This is allowing us to use this information to our benefit, not just for the knowledge for our own curiosities, but also to fight for complete usage of our health coverage, ensuring that the health insurance contracts we pay for are actually honored.

So, one of the simplest ways some are using AI to fight for their rights is the example of an insurer denying a hospital stay as not being medically necessary. Some are uploading that denial letter along with the hospital bill and their insurance policy to their favorite AI, which scans the bill for common errors (i.e., upcoding or unbundling) while also cross-referencing the denial letter from their insurance company. AI will compare all of this with thousands of publicly available successful appeal cases to draft a comprehensive and professional demand letter that the patient sends to the insurance company to smartly appeal the denial, citing specific billing codes and policy coverage clauses, etc.

Let’s show another example being used today for someone using Google’s Health Connect, using AI as an expert negotiator for a diabetic patient. Let’s say one has Type 1 diabetes and has their advanced insulin pump denied, with the insurance company stating that the pump is not medically necessary.

For months, the Type 1 diabetic used a continue glucose monitor, a CGM, that synce its data to an app on their phone app. Though Health Connect, for example, they have given their glucose app to share its blood glucose information with Health Connect.

The patient can easily use their favorite AI tool to appeal the denial for the insulin pump when they grant their AI tool, one-time permission to view the Health Connect data, and the patient uploads the denial letter along with their insurance info. In a minute, AI spits out a letter of proof (along with graphs of dozens of “hypoglycemic events) over the past 3 months showing the need for the pump. The patient uses the appeal letter to show that if the patient does not receive the pump, then the insurance company is putting their life in danger.

So, these are just two simple examples of how some are using AI to unleash powerful outcomes for their lives. Many more are coming down the pike. The question for many is, as positive as these outcomes may be, you are still giving very personal data over to the company running the AI. And aren’t many already doing that with their Pixel and Apple watches in addition to their cellphones, which are data troves.