If your health insurance company has ever denied a claim, you’re far from alone. Each year, nearly one in five in-network claims is rejected—yet less than 1% of patients ever challenge those denials.
Today, a new wave of tools powered by artificial intelligence is stepping in to level the playing field. One startup, Claimable, says it can craft personalized appeals in less than 30 minutes—slashing through the red tape that so often deters patients from fighting denied coverage.
How AI Appeals Work
Platforms like Claimable and Fight Health Insurance are harnessing AI to walk patients through the appeals process and generate powerful letters to challenge denials. Claimable, for instance, has users complete a 25-minute survey, then strengthens their case with peer-reviewed research and relevant state and federal laws before producing a tailored appeal.
Zach Veigulis, co-founder and chief AI officer at Claimable, likens the technology to having a team of insurance, medical, and legal experts working at your side on every appeal.
“What would take someone 30 to 50 hours, even if they were educated in writing an appeal, we’ve reduced that down to 30 minutes,” Veigulis said.
Claimable charges a flat fee of $39.95—whether you win or lose—along with postage costs to send appeal letters not only to your insurer but also, when necessary, to the state insurance department, the U.S. Department of Labor, your employer, and even local lawmakers.
Claimable’s reach is still limited. For now, it files appeals for 75 medications tied to more than a dozen conditions. But co-founder Zach Veigulis says the company’s goal is far broader: to eventually support appeals for every condition.
Fight Health Insurance offers a free alternative, guiding users to upload their denial and related documents so its chatbot can generate an appeal letter. Patients can also turn to general-purpose AI tools like ChatGPT or Google Gemini for help, though these platforms aren’t specifically designed for navigating insurance disputes.
What to Watch For
The Patient Advocate Foundation (PAF) supports people with chronic and life-threatening illnesses in navigating the complex health insurance system. Caitlin Donovan, a foundation spokeswoman, noted that drafting an appeal letter is a major challenge for many patients. She recommends that even when using an AI service, a human should review the letter to catch any inconsistencies.
“Obviously, having a really skilled person who knows how to work the system, and what levers to pull at the right times, is going to be better for you than an AI-generated Word document,” Donovan said. But, she said, not everyone has access to these services. “Something is better than nothing. The underlying cause of this is that our system is so complicated and so biased against the patient that we’ll take all the help we can get.”
Donovan urged patients to turn to PAF’s comprehensive guide on appealing denials for support.
A Growing Problem for Patients
Many health care providers report that insurance denials are on the rise—and growing increasingly complex. Caitlin Donovan noted that a decade ago, PAF case managers typically needed about 22 calls to resolve a case; today, that number has climbed to 30.
Veigulis highlighted a troubling pattern: insurers frequently deny claims in direct contradiction to their own medical policies, or they enforce rules that are far stricter than widely accepted clinical guidelines.
In certain instances, insurance companies make coverage decisions driven by financial considerations rather than medical need. On July 1, for example, CVS Caremark removed the weight-loss drug Zepbound from its formulary, citing a goal to "balance access and affordability," and replaced it with Wegovy as its preferred obesity treatment. Veigulis noted that Claimable has already developed an appeals strategy to support patients impacted by the change.
The Bottom Line
Each year, health insurers reject millions of claims, yet only a small fraction are ever appealed. Companies like Claimable are stepping in, leveraging AI to craft personalized appeal letters for a flat fee. Experts, however, caution that these letters should always be reviewed by a human to ensure accuracy. As claim denials continue to climb, AI tools could provide patients with a crucial first step in challenging their insurance decisions.
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