Revealed: How Claimable’s AI Works for Patients

A behind the scenes look at how Claimable’s AI works to help patients level the playing field and reclaim control of their care and coverage.

AI and automation have, for better or worse, become a common part of the health insurance industry. These technologies are used daily by insurers to review claims and, often unjustly, deny them. At Claimable, we’re building AI tools that empower you - the patient. We’re leveling the playing field, leveraging technology to help you reclaim control and get the care you’re owed.

But what does that mean exactly? Let’s dive in and explore how our AI technology works, and why it gives you an appeals advantage unlike anything else. 

Who are the real-life people behind your AI? 

First, let me introduce myself. I’m Zach, Chief AI Officer. Before co-founding Claimable I spent nearly 15 years at the US Department of Veteran Affairs, serving most recently as Chief Data Scientist. I’m also a lecturer at the University of Iowa Tippie College of Business. All that to say, I’ve devoted my career to building innovative technologies that improve patient’s access to care. 

At Claimable, my team of engineers worked hand in hand with accredited doctors and insurance insiders, spending months researching, developing, and fine-tuning our AI-powered appeals platform.

How is AI Being Used to Generate My Appeal?

To start, we gather the details of your case. Don’t worry, it’s easy. We’ll ask you a few questions and have you upload relevant paperwork. From there, AI takes care of the rest. Our custom-built technology takes your specific case details and cross-references them against a huge database of published medical evidence, applicable laws, and other relevant sources. Using large language models and machine learning algorithms, we synthesize large amounts of data into a clear, legally sound argument advocating for your right to receive care. 

In addition to gathering relevant information, our AI is trained to recognize patterns in successful appeals and apply these insights to new cases, continually improving over time and allowing you to leverage the success of previous appeals in your own.

Will It Be Personalized to My Situation, or a Form Letter?

Every appeal generated by Claimable is highly personalized. It assesses each case on its merits, considering individual patient details, medical history, and relevant precedents. Unlike generic form letters, each appeal is uniquely tailored to address the specific points of your denial, significantly improving the likelihood of a successful outcome.

Are Any Humans Involved In The Process, Or Is It 100% AI-generated? 

The process of creating your appeal is done exclusively by AI. Think of it like having your very own team of AI-powered researchers, writers, and editors. The researcher and wordsmith AI draft your appeal, and the editor AI makes sure everything is correct and trustworthy. This two-step process ensures that your appeal is both correct and compelling. If there are issues with an appeal, our review team can work to resolve them. 

Will It Sound Like A Robot Wrote It?

Our AI is programmed with advanced language models that produce text indistinguishable from a human professional. In other words, no robot voice here. We understand the importance of tone and language in appeals, and our AI captures them expertly. This ensures your appeal document is not only effective but also empathetic and articulate.

Will I Need to Know How to Word a Prompt?

No, you do not need to know how to word a prompt for our AI. The system is designed to be user-friendly; you simply share the necessary details of your denial, and the AI handles the rest. The Claimable experience guides you through every step of the way, no technical experience required.  

I’m Not An Appeals Expert, Am I Expected To Catch Mistakes?

We don’t expect you to be an expert. Few people, including most doctors, are! That is why Claimable includes multiple layers of checks. After the initial draft is created, other AI models, trained as reviewers, analyze the content for errors or misrepresentations, correcting them before the appeal is finalized. Learn how to review an appeal here.

How Do You Prevent Hallucinations?

A hallucination is a response generated by AI that contains false or misleading information presented as fact.

If an inconsistency is detected, the system automatically flags and revises the questionable content, ensuring reliability and accuracy.

What If I Need To Reach An Actual Human For Help? 

Once your appeal is ready, you'll have the opportunity to review it. If you spot anything that doesn’t look right, you can mark it for further examination. Our system is designed to catch and correct most issues automatically. However, if there’s a need for additional oversight, our team is prepared to step in and ensure everything is handled correctly, providing support when necessary.

Wouldn’t It Be Better If My Doctor Did This vs AI? 

While doctors are experts in medicine, they are not trained in insurance appeals. Claimable specializes in legal argumentation and persuasive writing, often outperforming standard doctor-written appeals in terms of depth, thoroughness, and compliance with legal standards.

That said, your doctor can still support your appeal process. Learn more about how best to work with your doctor here. 

How Is This Different From ChatGPT and Similar Platforms? 

It not only stays updated with the latest medical evidence, legal changes and recent case developments but is also built to comply strictly with HIPAA regulations. This ensures that all your personal and medical information is handled with the utmost security and confidentiality, safeguarding your privacy throughout the process. This tailored focus and commitment to compliance make Claimable uniquely reliable and secure for handling sensitive medical appeals.

Is My Health Information Safe? 

All of your data is handled with strict adherence to HIPAA regulations, ensuring your personal information is protected with the highest standards of security and confidentiality. Claimable uses encrypted data storage and transmission protocols to safeguard your information from unauthorized access.

Lawyers are expensive, and doing it yourself takes huge amounts of time and expertise that most of us just don’t have. By leveraging Claimable’s AI-powered platform, you have access to a powerful, efficient, cost-effective, and safe solution, right in the palm of your hand. Insurers are making technology work for them, it’s time you do too.