NBC News released a groundbreaking national story "AI is helping patients fight health insurance denials". In it, Pulitzer Price winning reporter Gretchen Morgenson shares how artificial intelligence tools are rapidly being developed to help patients and clinics fight denied health insurance claims by generating well-crafted appeals letters. Prominently featured was AI startup Counterforce Health, which offers the leading suite of AI tools to help patients and healthcare providers appeal denied health insurance claims.
Excerpt below:
'You have rights'
Tabitha Lee is a former paramedic working in rheumatology at Wilmington Health in North Carolina. Since January, she has handled prior authorization and insurance denials for the roughly 100 patients who come in each day.
Denials have ramped up recently, she said.
“We’ve had a lot of patients on medication for years, stable and well-controlled, and insurances were denying them,” Lee told NBC News. Instead, the insurers would suggest alternative drugs that were on their approved lists, or formularies, she said. This was causing trouble for patients, Lee added, because “changing patients’ medications can cause adverse reactions.”
Lee said she had tried filing appeal letters for patients but it was time-consuming to compile the scientific and clinical testing data on each case. In February, at the suggestion of a rheumatologist and adjunct professor at the Duke School of Medicine, she began filing appeals using an AI-generated system created by Counterforce Health, a nonprofit founded by Neal K. Shah, a former hedge fund manager turned health care entrepreneur and advocate. Shah is also chief executive of CareYaya Health Technologies, a nonprofit that connects college students pursuing health care degrees with families seeking care for aging relatives.
At no charge, Counterforce generates customized appeal letters based on a patient’s insurance policy and the current record of successful appeals related to the drug or treatment in question. The letters also go to insurance regulators in the patients’ states to alert them to the denials, which Shah said they may not be aware of.
“Denials should be appealed, but we observe most people don’t appeal because they are intimidated by whole thing,” Shah said. His message to patients: “When you get a no, please take the next step — you have rights.”
Lee said using the Counterforce software has helped her overturn denials. “I’ve gotten back approvals on the same day and the day after,” Lee said. “It definitely limits the time we have to spend formulating each denial letter and allows me to work more on initial prior authorization and patient assistance.”
Full story here: https://www.nbcnews.com/news/us-news/ai-helping-patients-fight-insurance-company-denials-wild-rcna219008