| Americans seeking medical care are often told no. Health insurance companies or other intermediaries can deny requests for prescribed medications or refuse to pay for care after it's provided. Patients have legal rights to appeal those decisions, but many don't. A new startup, Claimable, aims to help US patients fight back. It draws on AI and a body of medical evidence and legal knowledge to generate appeals letters. "The goal of the company is to give patients an avenue to be heard and not feel helpless in the face of an insurance denial," says Warris Bokhari, the chief executive officer and co-founder. Bokhari, 44, practiced as a doctor in London before working at a series of health and tech companies in the US, including Apple, Amazon and the insurance company now known as Elevance Health. He co-founded Claimable last year after observing patients facing denials "that should never have been issued," he said, and would likely be overturned if they appealed. Most don't. Only 10% of denials in private Medicare Advantage plans were appealed, according to an analysis of federal data from health researcher KFF, but most of those appeals succeeded in getting the insurer to reverse the denial. In Affordable Care Act plans, less than two-tenths of 1% of in-network denials were appealed, KFF said in a separate report. Claimable is just starting out. The company put the system through extensive testing before its launch in early October. Since then, it's filed less than 100 appeals so far, Bokhari says. In testing ahead of the launch, patients won 80% of the appeals filed through the site. For now, it's only set up to handle claims for a limited number of medications — expensive drugs like Enbrel or Humira that frequently face restrictions on coverage. Patients pay $40 plus shipping to send the letters. The website prompts patients to upload their denial letters and answer some questions about their situation. Then it taps a library of medical, legal and policy knowledge. Claimable uses the AI engine behind ChatGPT to generate an appeal letter, but the system makes sure the large language model is constricted by "so many guardrails," Bokhari says. "It doesn't have the capacity to invent data." Claimable also gives patients the option to send copies of their appeals to powerful people, including insurance company executives, state regulators, governors and federal officials. That kind of escalation can be critical in getting a quick response to an appeal, Bokhari says. Since launching, he says, Claimable hasn't lost an appeal yet. — John Tozzi | 
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