An excellent use for LLMs: fighting insurance claim denials!

[thewayne]

A tech worker in San Francisco needed surgery after an accident and faced a spate of claim denials, so she fought back, appealing all of them. And over 90% of the roughly 40 denials were approved on reconsideration. She even got a denial overturned on appeal for surgery for her pet dog!

So she started helping friends with the process.

Well, there's one thing about us programmers. When we start doing something repeatedly, we start thinking "How can we automate this and improve it?"

So she turned to large language models, commonly known as AI.

And it seems to be working pretty good!

Scan in your denial letter, and her system will generate several appeal letters for you to pick and choose from, you can also modify as you see fit.

A study showed that only about a tenth of one percent of rejected claims of participants in the ACA appeal. My doctor's office has handled this for me in the past, I've also joined in the fight a couple of times, and they've always been overturned thus far. It's definitely worth the fight, and this will make it a lot easier to do!

The actual web site is at: https://fighthealthinsurance.com/

She put a year of her time and $10,000 of her own money into this project! It's free for now, though she may charge for add-on services such as faxing an appeal directly to your insurance.

https://sfstandard.com/2024/08/23/holden-karau-fight-health-insurance-appeal-claims-denials/

https://science.slashdot.org/story/24/08/31/2131240/tech-worker-builds-free-ai-powered-tool-for-fighting-us-health-insurance-denials

Comments

[ranunculus]

Found you while flipping through "network" on Dreamwidth. I see that we have Pondhopper in common.

[thewayne]

Welcome!  I can't remember who, but a friend pointed me to her, she's a nice lady and has a good eye for photography.  I think it was because I mentioned Spain or Portugal as a possible European destination for my wife and I to retire to in a few years.

[ranunculus]

Pondhopper and I go way back to LJ Days, I have no idea how I originally "met" her. On my bucket list is a trip where we stop to see her...

[kaishin108]

Hi, I'm friends with pondhopper too. Wondering if you would like to friend up. :)

[disneydream06]

WOW.....
Way to go her. :)
Glad to hear somebody is fighting back. :)
Hugs, Jon

[motodraconis]

On the one hand, what she has done is great, but on the other, that such things are needed is beyond tragic.

This is why I will never work in the US, and to be honest, even if I was allowed in, I'm not sure I want to risk a another visit.

[thewayne]

No, I would not recommend coming here unless you had exceedingly good travel medical insurance that explicitly covered the USA - I understand some travel policies are now excluding us.

[madamoiselle_sambuca]

Wow! Amazing Wayne, good for her!

[silveradept]

This is one of those situations where I feel the use of text generators might be appropriate, but I would want it to be a narrowly-focused one that could be run on your own hardware. Because I'll bet the generation of the denial paperwork was done automatically and with as little effort and greatest contempt for the patient, so the appropriate response is to generate an appeal with as little effort and great contempt for the denial as possible. (Of course, the whole thing could be mooted if insurance companies actually did their job, instead of trying to make the most profit possible.)

[thewayne]

Considering how much of the medical industry is increasingly owned by the vulture capital industry, profit is the only motive.

[silveradept]

Even more reason to require that medicine is no-profits and to completely evaporate the medical and dental insurance sectors and replace them with socialized medicine. Forcibly remove the profit motivation from thw entire sector so that instead they can do what they actually have to.

[kaishin108]

What a great human being to do that, wow. And thank you for posting about it. I saved the link as you never know. So far my insurance has been okay but well, it is insurance in the US!