The idea that American health insurance companies are using AI to analyze and arbitrate claims for approval or denial is scary, but one North Carolinian is using AI to fight back.
When Neil Shah, a resident of Raleigh, made a rejected claim to his wife's chemotherapy drugs, he thought he was the only person and it was rare that it was unlucky.
Singing his case over the phone, which had been running for hours, changed his husband and father, and he set out to create a sophisticated app that uses artificial intelligence to compare claim refusal forms against health insurance policies.
“It's not rocket science for a doctor to write this, but it still takes several hours,” Shah told ABC News 11, and although a well-written appeal sent immediately can overturn the denial within days or weeks, most people don't know that they can or don't know that they can or don't know that they can appeal it.
In fact, according to Shah's investigation, 850 million claims are denials each year, with less than 1% being appealed.
That's where Counterforce Health comes in. This is a startup that created a free, usable app to reject claims.
It's even more important that health insurance companies already armed with statewide government-protected pseudo monopoly and Dupoly are using AI to deny claims within seconds of filing.
“Previously you had a reason to deny it, and you had a doctor review or nurse review it, but once the AI was deployed, they could deny it,” explained Shah.
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For the health of the Counterforce, Shah has been equipped with Riya Jadhav, the jill of all trades that helped him grow and expand his business by working with patients at Johns Hopkins University Hospital through his experience in the business world.
Together, they built a counterforce to points with a 70% success rate on attractive bills.
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Thousands have already been logged on. Many people are trying to use the service.
“I feel like I'm really trying to click because I think when enough people get noisy and enough people put pressure on me, a sudden society is awakening,” Shah said.
Check out the following story from ABC 11…
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