A UK entrepreneur is using artificial intelligence (AI) to challenge the longstanding issue of health insurance claim denials in the United States, with an impressive success rate of over 85 percent.
Warris Bokhari, co-founder and CEO of Claimable, launched the startup two years ago to empower patients and push back against systemic barriers within the US healthcare system.
Tackling Denials with AI
Claimable, an AI startup launched in October, is now dedicated to challenging claim denials for an expanding range of treatments.
"It's no wonder why people give up," Bokhari told Business Insider. "If you're a rational person, you would say this model was not fit for purpose."
Raised in the UK alongside two disabled parents, Claimable's cofounder and CEO, Bokhari, observed a stark contrast with the US healthcare system.
Unlike many Americans, his parents never faced bankruptcy due to medical expenses.
After working as an ICU doctor in the UK, Bokhari noted that there was "never a time" when a necessary treatment was withheld from a patient.
When he came to the US, Bokhari continued working in the healthcare industry, including a two-year stint at Anthem, an insurance company.
A Deep-Rooted Issue In The US Healthcare System
Bokhari observed that there's no guarantee of receiving necessary medical care in the US. Insurance companies can often hinder access to care, fostering a climate of fear and apprehension among individuals regarding illness.
The recent killing of UnitedHealthcare CEO Brian Thompson has cast a harsh spotlight on the insurance industry.
While the motive behind the attack remains unclear, the public outcry that followed has laid bare the deep-seated frustrations many Americans harbour toward the industry.
Bokhari emphasised that the company does not condone violence against individuals, stating, "That is not the productive solution," Bokhari said. "The productive solution is appealing."
Claim denial rates have been on a steady upward climb for over a decade.
The health policy and research firm KFF reported a concerning statistic in 2021: a staggering 17 percent of in-network claims submitted to HealthCare.gov insurers were denied.
The report further indicated that while 41 percent of appealed claims were overturned, less than 1 percent of consumers initiated the appeal process.
Additionally, recent criticism has focused on insurance companies that employ algorithms to assist in making claim decisions.
Bokhari shared that Claimable has assisted in filing hundreds of appeals, boasting an impressive success rate of over 85 percent in overturning denials.
Empowering Patients Through Technology
Claimable is one of several startups harnessing AI to streamline and enhance the insurance process.
Patients begin by detailing their experiences with the condition and the potential consequences of a treatment denial.
The platform then leverages AI to analyse millions of data points, including clinical research, historical appeal precedents, policy specifics, and the individual's medical history.
Within minutes, the platform generates a tailored appeal. Most Claimable appeals cost patients £31.55 ($39.95), plus a shipping fee.
Claimable supports claims appeals for over 70 FDA-approved treatments for autoimmune and migraine sufferers, some of which have been denied due to claims of medical necessity or out-of-network provider status.
Claimable's Unique Approach
In addition to traditional methods like faxing and mailing the appeal to the insurance company, Claimable proactively sends a copy to every relevant regulatory agency overseeing the insurer.
"Regulators probably assume that these denial cases are occasional," Bokhari said. "They make big headlines, but they don't know that these very private tragedies happen every day in American life."
Bokhari asserted that patients "have a right to be heard," and Claimable empowers them by legitimising their stories.
In March, Claimable successfully closed its seed round, securing funding from Walkabout Ventures, Humanrace Capital, and other investors.
The company participates in Nvidia's startup program and currently employs approximately 11 individuals.
