A growing number of patients are resorting to artificial intelligence (AI) bots to battle health insurers that deny care, leveraging the same technology used by insurers themselves. In response to the rising tide of denied claims and medical bills, entrepreneurs and nonprofits have developed AI-powered tools to help patients navigate complex insurance policies and medical billing.
Sheer Health, a three-year-old company, has launched an app that allows consumers to connect their health insurance accounts, upload medical bills, and ask questions about deductibles, copays, and covered benefits. The program uses both AI and humans to provide answers for free, with patients who want extra support in challenging a denied claim or dealing with out-of-network reimbursements able to pay the company to handle those for them.
In North Carolina, the nonprofit Counterforce Health has designed an AI assistant to help patients appeal their denied health insurance claims. The free service uses AI models to analyze a patient's denial letter and draft a customized appeal letter, providing patients with a better chance of getting their claims paid.
As states scramble to regulate the use of AI in healthcare, businesses and nonprofits are taking matters into their own hands. According to a recent poll by the health care research nonprofit KFF, 25% of adults under the age of 30 have used an AI chatbot at least once a month for health information or advice.
State legislators on both sides of the aisle are passing new regulations that govern how insurers, physicians, and others use AI in healthcare. Already this year, more than a dozen states have passed laws regulating AI in healthcare, according to Manatt, a consulting firm.
Despite the growing regulatory efforts, experts warn that AI tools can be vulnerable to mistakes and bias. Carmel Shachar, assistant clinical professor of law at Harvard Law School, notes that "AI doesn't feel like a satisfying outcome to just have two robots argue back and forth over whether a patient should access a particular type of care."
Dr. Arvind Venkat, a Democratic Pennsylvania state representative, agrees, stating that "if we're able to harness this technology to improve the delivery and efficiency of clinical care, that is a huge win." However, he also emphasizes the need for government regulation and human oversight to ensure AI is used in a way that looks at the individual patient.
As patients increasingly turn to AI tools to fight denied claims and medical bills, experts caution that relying solely on AI can be problematic. "It's why we need government regulation and why we need to make sure we mandate an individualized assessment with a human decisionmaker," Venkat said.
Ultimately, the key to effective AI in healthcare lies in striking a balance between technology and human oversight. While AI has the potential to improve patient experiences and overall provider experience, it is essential to ensure that patients have access to accurate information and support from trained professionals.
Sheer Health, a three-year-old company, has launched an app that allows consumers to connect their health insurance accounts, upload medical bills, and ask questions about deductibles, copays, and covered benefits. The program uses both AI and humans to provide answers for free, with patients who want extra support in challenging a denied claim or dealing with out-of-network reimbursements able to pay the company to handle those for them.
In North Carolina, the nonprofit Counterforce Health has designed an AI assistant to help patients appeal their denied health insurance claims. The free service uses AI models to analyze a patient's denial letter and draft a customized appeal letter, providing patients with a better chance of getting their claims paid.
As states scramble to regulate the use of AI in healthcare, businesses and nonprofits are taking matters into their own hands. According to a recent poll by the health care research nonprofit KFF, 25% of adults under the age of 30 have used an AI chatbot at least once a month for health information or advice.
State legislators on both sides of the aisle are passing new regulations that govern how insurers, physicians, and others use AI in healthcare. Already this year, more than a dozen states have passed laws regulating AI in healthcare, according to Manatt, a consulting firm.
Despite the growing regulatory efforts, experts warn that AI tools can be vulnerable to mistakes and bias. Carmel Shachar, assistant clinical professor of law at Harvard Law School, notes that "AI doesn't feel like a satisfying outcome to just have two robots argue back and forth over whether a patient should access a particular type of care."
Dr. Arvind Venkat, a Democratic Pennsylvania state representative, agrees, stating that "if we're able to harness this technology to improve the delivery and efficiency of clinical care, that is a huge win." However, he also emphasizes the need for government regulation and human oversight to ensure AI is used in a way that looks at the individual patient.
As patients increasingly turn to AI tools to fight denied claims and medical bills, experts caution that relying solely on AI can be problematic. "It's why we need government regulation and why we need to make sure we mandate an individualized assessment with a human decisionmaker," Venkat said.
Ultimately, the key to effective AI in healthcare lies in striking a balance between technology and human oversight. While AI has the potential to improve patient experiences and overall provider experience, it is essential to ensure that patients have access to accurate information and support from trained professionals.
! I mean, can you imagine having an app that helps u navigate all those crazy insurance policies? It's like a superhero for ur wallet 
! And these AI assistants are literally drafting appeal letters 4 patients who got denied claims - talk about a leg up 
. But, at the same time, experts are warning us that AI tools can be super sketchy if not regulated properly 
. Like, what if it's biased or makes mistakes? We need those human decisionmakers in the mix to make sure patients get the best care possible 
. Still, I'm all for harnessing tech 2 improve healthcare outcomes - just gotta find that balance between AI and human oversight 
!
. I mean, shouldn't they just make things easier for us patients? Like, isn't the whole point of having an app to connect your accounts and ask questions about deductibles and stuff? But now it's like... what if the AI bot makes a mistake? 
And what about those states that are passing laws regulating AI in healthcare? I don't get why we need more rules. Can't they just make sure these bots are accurate and unbiased first? 
I guess I just want to know for sure: can I really trust an AI bot to help me with my medical bills? 
. Don't get me wrong, I'm all for innovation and progress, but sometimes you just can't beat a good ol' fashioned human conversation 
.
. Now, I'm not against regulation or anythin', but it feels like we're just throwin' a bunch of rules at the problem without thinkin' about the bigger picture 
.
It's just crazy, man. We need to make sure that AI is used in a way that complements human healthcare, not replaces it 
. I mean, we're talkin' bias, mistakes, and all sorts of other issues 
?
. And what happens when there's a mistake or bias in the system? It could have serious consequences for patients 
. We need more regulation and oversight to ensure that these tools are developed and used responsibly 
.
.
. Like I know some people are using AI bots to help them fight denied claims and medical bills... that sounds like a total game-changer for them! 
But, can you imagine if we had an app like Sheer Health in our school? It would be so helpful to connect our health insurance accounts and get answers about our deductibles and copays. 
I wish we could have something like Counterforce Health's AI assistant to help us appeal denied claims... that would save us so much time and stress! 
.
