The CEO using AI to fight insurance-claim denials says he wants to remove the 'fearfulness' around getting sickNEWS | 16 December 2024Warris Bokhari founded Claimable to tackle insurance-claim denials using AI technology.
Bokhari says denial is a major issue in the US healthcare system, causing fear about getting help.
Claimable's AI-driven platform boasts an 85% success rate in overturning claim denials.
After working in the insurance industry, Warris Bokhari saw that claim denial was a core issue in American healthcare.
So around two years ago, Bokhari started working on Claimable, an AI startup launched in October that aims to fight claim denials for a growing list of treatments.
"It's no wonder why people give up," the Claimable cofounder and CEO told Business Insider. "If you're a rational person, you would say this model was not fit for purpose."
Bokhari was raised in the UK and grew up with two disabled parents. Unlike people in the US, his parents never went bankrupt because of medical expenses, he said. He went on to work as an ICU doctor in the UK, where, he said, there was "never a time" when a necessary treatment was denied to a patient. When he came to the US, Bokhari continued working in the healthcare industry, including a two-year stint at insurance company Anthem.
In the US, he said, "there's no guarantee" of getting the medical care you need. Insurance companies can end up feeling like an obstacle, and that dynamic has created "fearfulness" about getting sick and seeking out help, Bokhari added.
The insurance industry has faced renewed scrutiny amid the fatal shooting of UnitedHealthcare CEO Brian Thompson. While the motive behind Thompson's killing is under investigation, many of the responses to his death online have disclosed deep frustrations with the insurance industry.
Bokhari said the company didn't support violence toward individuals. "That is not the productive solution," Bokhari said. "The productive solution is appealing."
Claim-denial rates have been increasing for more than a decade. The health policy and research firm KFF reported that 17% of in-network claims by HealthCare.gov insurers were denied in 2021. The same report found that 41% of appealed claims got overturned, though less than 1% of consumers went through the process. Recent criticism has also been directed toward insurance companies that can rely on algorithms to assist in claim decision-making.
Bokhari said that Claimable had helped file hundreds of appeals and that its success rate of overturning denials was about 85%. It joins several startups leveraging AI to improve the insurance process.
Patients start by describing their experience of living with the condition and what it would mean to get denied their requested treatment. The platform then uses AI to analyze millions of data points from clinical research, appeal precedents, policy details, and the individual's medical history to generate a customized appeal within minutes.
Most Claimable appeals cost patients $39.95, plus shipping.
Claimable supports claims appeals for more than 70 FDA-approved treatments for autoimmune and migraine sufferers, some of which may have been denied because of medical necessity or being out of network. In addition to faxing and mailing the appeal to the insurance company, Claimable also sends a copy to every regulator that would have oversight of 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 said patients "have a right to be heard," and Claimable helps legitimize those patients' stories.
Claimable closed its seed round in March, backed by Walkabout Ventures, Humanrace Capital, and others. The company is a part of Nvidia's startup program and has a team of about 11 employees.Author: Ana Altchek. Source
