Taking on America’s Health Insurance Bureaucracy With AI
Neal K. Shah talked about an artificial intelligence innovation that can be used to fight denied health insurance claims, thus improving revenue cycle management for physicians' practices and the patient experience.
I never expected that a battle with health insurance companies over a $32,000 denied claim would lead to creating technology to help medical practices fight back. For health care providers, these battles are all too familiar.
Neurology practices face some of the
Denials management is a
Insurance companies deploy artificial intelligence (AI) to automate claim rejections, hitting neurology practices especially hard. AI systems flag ongoing treatment plans for denial without considering individual medical necessity or the progressive nature of many neurological conditions. Even Medicare Advantage plans meant to help older adults frequently deny neurological care, with
That's why we launched
For example, when insurers deny coverage for plasma exchange treatments in patients with
Some will argue that insurance companies help control health care costs—but just look at the skyrocketing costs of health insurance facing individuals across America.
Providers like you know the reality: Denial strategies often target legitimate, necessary care while massively ballooning administrative overhead. For conditions requiring timely intervention, these delays can significantly impact patient outcomes. And for postcare denials, it unwittingly turns the health care provider into a bill collector, damaging the patient-provider relationship that is at the heart of health care.
The system is broken, and we need more technological innovation and systemic reform. With the
No provider should spend more time fighting insurance companies than treating patients. With the right tools, you don't have to. It's time to put advanced technology to work for neurology practices.
REFERENCES
1. Which physicians have the most claims denied, resubmitted? a specialty breakdown. Becker’s ASC Review. May 21, 2020. Accessed January 28, 2025. https://www.beckersasc.com/asc-coding-billing-and-collections/which-physicians-have-the-most-claims-denied-resubmitted-a-specialty-breakdown.html
2. Patel AS. Why insurers keep denying claims (and what to do). Medscape. December 18, 2024. Accessed January 28, 2025. https://www.medscape.com/viewarticle/why-insurers-keep-denying-claims-and-what-do-2024a1000ndb?form=fpf
3. Payer denial tactics — how to confront a $20 billion problem. American Hospital Association. Accessed January 28, 2025. https://www.aha.org/aha-center-health-innovation-market-scan/2024-04-02-payer-denial-tactics-how-confront-20-billion-problem
4. Stephenson J. Federal investigators find Medicare Advantage plans too often deny, delay needed care. JAMA Health Forum. 2022;3(5):e221781. doi:10.1001/jamahealthforum.2022.1781
5. Levine A, Chambers J. How might US health plans cover efgartigimod for generalized myasthenia gravis? lessons from the SPEC database. Center for the Evaluation of Value and Risk in Health. November 4, 2021. Accessed January 28, 2025. https://cevr.tuftsmedicalcenter.org/news/2021/how-might-us-health-plans-cover-efgartigimod-for-generalized-myasthenia-gravis-lessons-from-the-spec-database
6. Tian N, Kobau R, Zack MM, Greenlund KJ. Barriers to and disparities in access to health care among adults aged ≥ 18 years with epilepsy - United States, 2015 and 2017. MMWR Morb Mortal Wkly Rep. 2022;71(21):697-702. doi:10.15585/mmwr.mm7121a1
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