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A new website, FightHealthInsurance.com, is empowering Americans to take on health insurance companies over denied claims by simplifying the process of appealing claim denials.
Newsweek has contacted Silicon Valley software engineer Holden Karau, who built the website, for comment via email.
Why It Matters
In the wake of the shooting of UnitedHealth CEO Brian Thompson, there has been an outpouring of anger toward the insurance industry for denying medical claims, with some going as far as cheering for Thompson's death and arguing that the shooter was justified in his actions. Public scrutiny has especially been focused on the alleged use of AI by health insurers in evaluating claims.
Following Thompson's death, FightHealthInsurance.com has been gaining increased attention in recent weeks.
What To Know
The platform allows users to upload and process insurance denials, identifying the procedure denied and the reason provided. Users can confirm details, upload supporting documents, and generate appeal drafts tailored to their needs. Appeals can be printed or faxed directly through the platform for a $5 fee. The website uses AI to carry out the process.
Karau, who is a trans woman, said she built the website after her own experiences with the health insurance system. She added that she aims to level the playing field with her website, emphasizing that insurers hold a significant advantage over both patients and doctors because of their access to extensive data and advanced AI tools.
The Context
It comes as legislators in different U.S. states are clamping down on health insurance companies' use of artificial intelligence to evaluate claims.
A U.S. Senate report from October revealed that insurers have used AI tools to deny Medicare Advantage claims, with UnitedHealthcare's denial rate for post-acute care doubling from 10.9 percent in 2020 to 22.7 percent in 2022. This increase coincided with the use of an AI model, nH Predict, developed by naviHealth, a UnitedHealth Group subsidiary.
While nH Predict analyzes vast data to make recommendations, experts warn that claims of its accuracy may be overstated. UnitedHealth is currently facing lawsuits over its use of nH Predict. One alleges that insurers pressured case managers to follow AI recommendations over objections from clinicians and families. Another claims 90 percent of these decisions are overturned on appeal.
Last week, California implemented the Physicians Make Decisions Act to ensure that decisions about medical treatments are made by licensed health care providers and not solely by AI algorithms used by health insurers.
New legislation in several other states is also targeting health insurers' use of AI and expanding coverage requirements. Georgia, New York and Pennsylvania may mandate insurers to disclose when AI is used in claims handling. Pennsylvania could further require state-regulated plans to report AI tools to the state insurance department. Oklahoma may require insurers to publicly disclose AI use and submit algorithms and datasets for review.
UnitedHealthcare is also under scrutiny after a Massachusetts judge ordered three UnitedHealth-owned insurers to pay over $165 million for misleading customers into purchasing unnecessary supplemental health insurance. The ruling found that HealthMarkets and its subsidiaries marketed bundled policies between 2012 and 2016 in a deceptive manner. UnitedHealthcare previously told Newsweek it plans to appeal the decision.
What People Are Saying
Holden Karau told Quartz: "I would say experiencing the American health care system as a trans person, you get to experience a lot of health insurance denials."
Karau added that she also suffered injuries when she was struck by a car.
"That gave me a motivation to think about this problem," she said. "I think that there could be some significant changes if we can make it more expensive for them to deny care. One of the ways is appealing these denials."
California state Senator Josh Becker, in a previous statement to Newsweek, said: "Our health care system is riddled with systemic issues that prevent patients from receiving the care they deserve. No other industrialized country's health care system operates like ours. We can't have a system that routinely delays or denies necessary care. Patients often face hurdles like endless prior authorizations, surprise billing, and restrictive networks, which disrupt their access to timely and necessary treatment. Stronger regulations are essential to ensure health care decisions are made by physicians in consultation with their patients—not dictated by insurance company policies driven by profit."
What Happens Next
Healthcare CEOs have vowed to address growing frustrations among Americans struggling with access to and costs of medical care after Thompson's death.
In response to the tragedy, UnitedHealth Group CEO Andrew Witty acknowledged public frustrations in an op-ed for The New York Times, admitting that "the health system does not work as well as it should, and we understand people's frustrations with it. No one would design a system like the one we have. And no one did. It's a patchwork built over decades."
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About the writer
Martha McHardy is a U.S. News reporter based in London, U.K. Her focus is on polling and California politics. She ... Read more