“I realized that if you could invert and and actually give patients the ability to argue articulately against the insurer, you might actually change someone’s life,” says Bokhari, the CEO and co-founder of Claimable.
Using AI to help with medical bills only became realistic in the last few years, says Holden Karau, one of the founders of Fight Health Insurance. Open generative models—AI systems with publicly available code that users modify to their own purposes—only became good enough to help build this kind of system in early 2024, Karau says.
“That’s when the models got good enough that it was like, yeah, we can actually do this, let’s make it available for people to use,” she says.
It can be difficult to build an AI model that helps people appeal denials because the insurer—not the patient—usually has most of the information about why they’re denying claims and what makes them overturn their appeals, say Karau and her co-founder Melanie Warrick. But the two still found data to build into their model, including published information from state regulators about what language they used to overturn insurers’ denials.