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After success reversing Cigna denial for Idaho family, Claimable expands appeals platform to help all children obtain essential care.
PANS/PANDAS families can now get free appeal support, starting soon.
SACRAMENTO, Calif., Nov. 21, 2024 (GLOBE NEWSWIRE) (updated Nov. 25, 2025)
Claimable, a pioneering healthcare technology company, today announced the launch of its free AI-powered appeals platform designed to help children with PANS/PANDAS overcome insurance denials and access critical intravenous immunoglobulin (IVIG) treatment.
Families can start a free appeal now by visiting www.getclaimable.com/pans-pandas.
The Claimable platform leverages purpose-built AI to analyze clinical research, policy details, appeals data, and patients’ unique medical stories, generating and submitting customized insurance denial appeals in minutes.
The PANS/PANDAS solution was inspired by the family of Gianna Coulter. After being denied IVIG treatment three times by their insurer, Cigna, Gianna lost the ability to speak, eat, and walk for the majority of the day. Claimable stepped up to support them in filling a customized appeal. Within 96 hours they won. Cigna’s decision was reversed and they were reimbursed for previously made out-of-pocket payments. On the heels of this success, Claimable is now offering appeals support to all PANS/PANDAS patients at no cost, ensuring families do not incur any additional expenses in their fight for care.
"When I spoke to the Coulter family, it was clear to me that not only was this a medical issue of their daughter desperately needing care, but also the economic hardships would be more than any family could reasonably bear,” shares Warris Bokhari, co-founder and CEO of Claimable.
“I spoke to 12 families across 12 different states in the span of two days, and their stories were heartbreaking; divorces, foreclosures, bankruptcy - all to get access to one treatment and give their kids a shot. There was no way we could sit this out."
1 in 200 children in the US are estimated to be affected with PANS/PANDAS, a brain disorder that causes sudden onset psychiatric symptoms. The widely recommended treatment for PANS/PANDAS is IVIG, which involves infusing a patient with a concentrated pool of antibodies from healthy donors. IVIG is the mandated treatment in 12 states, but throughout the rest of the country families are facing senseless denials, and children are suffering and denied critical care.
“For far too long, families affected by PANS/PANDAS have faced senseless barriers when seeking insurance coverage for IVIG treatment, leaving them to navigate complex appeals processes alone while their children suffer needlessly. This free resource will empower thousands of families to advocate for the care their children desperately need. It would have been a huge support to my family, as well,” said Diana Pohlman, Advocate & Executive Director, PANDAS Network.org.
On average, a single IVIG infusion costs over $9,000 out of pocket, with some children requiring multiple infusions over years. Claimable has the potential to save families hundreds of thousands of dollars in out-of-pocket expenses. At a time when 100 million Americans struggle with medical debt, insurance coverage has never been more critical. Research shows that without adequate coverage, 60% of people delay care, and 47% experience worsening health as a direct result.
In addition to PANS/PANDAS, Claimable supports affordable appeals for over 70 life-changing treatments, focusing on commonly denied medications for autoimmune and migraine sufferers. The company aims to rapidly increase its impact, expanding to over 100 treatments by early 2025. This growth will include support for patients with Multiple Sclerosis, Cardiac Diseases, Diabetes, Obesity, Asthma, and individuals battling certain cancers. Claimable submits appeals via Fax and First Class Mail, requesting urgent 72-hour reviews when appropriate. Each appeal costs $39.95, plus shipping, except PANS/PANDAS appeals which are being offered for free.
Claimable is available nationwide and accepts denials from all insurance providers, including Medicare, Medicaid, United Healthcare, Anthem, Aetna, Cigna, and BCBS plans.
For more information about Claimable’s PANS/PANDAS tool, visit www.getclaimable.com/pans-pandas.
To learn more about Claimable and all of the treatments they support, visit www.getclaimable.com.
About Claimable: Claimable is revolutionizing the way patients fight healthcare denials, helping ensure everyone has access to the care they need and the coverage they deserve. The platform leverages custom-built AI to analyze clinical research, policy details, appeals data, and patients’ unique medical stories, generating and submitting customized appeals in minutes. Claimable is available nationwide, accepting denials from all insurance providers, including Medicare and Medicaid. As an NVIDIA Inception Program member, Claimable continues to push the boundaries of AI innovation in healthcare. For more information visit www.getclaimable.com.
Contact: Emily Fox, press@getclaimable.com
Pilot Program Boasts Industry-Leading Results with 80% Success in Under 10 Days
Sacramento, CA - October 2, 2024
Claimable, a pioneering healthcare technology company, today announced the launch of its AI-powered appeals platform designed to combat unjust healthcare denials. The platform leverages purpose-built AI to analyze clinical research, policy details, appeals data, and patients’ unique medical stories, generating and submitting customized appeals in minutes.
"At Claimable, we're harnessing the power of AI to give patients a voice in a system that too often drowns them out," said Warris Bokhari, MD, CEO and Co-Founder of Claimable. "Our mission is to level the playing field, ensuring every patient can reclaim control over their healthcare and get the treatment they’re owed."
The results from Claimable’s pilot program far exceed industry standards:
- An 80% appeal success rate (1.6x more than average)
- Most cases resolved in under 10 days (3x faster than average)
- Appeals submitted in minutes–not days
- Nearly $3M recovered for patients
These data illustrate the platform's potential to significantly impact millions of lives and protect patient rights amidst a broken insurance system. Annually, 850 million of the 5 billion U.S. health claims are denied, leading to care delays for 60% of affected patients, and 47% reporting worsened health as a result. Furthermore, 100 million Americans are in medical debt, accounting for 66% of personal bankruptcies. Claimable is addressing this mounting national healthcare crisis by empowering patients to swiftly challenge unjust denials, helping them access vital treatments, reduce financial burdens, and prevent critical care delays.
"Claimable’s AI-driven approach is a game changer for patients who have been unfairly denied care," said Julie Baak, Practice Manager at Arthritis Center in Bridgeton, Missouri. "It gives them a fighting chance to overturn these decisions and get the right coverage for the right treatment."
Currently, Claimable supports appeals for 60 life-changing treatments, focusing on commonly denied medications for autoimmune and migraine sufferers—conditions affecting nearly 65 million Americans, of which 80-85% are women. The company aims to rapidly increase its impact, expanding to over 100 treatments by early 2025. This growth will include support for patients with Multiple Sclerosis, Cardiac Diseases, Diabetes, Obesity, Asthma, and individuals battling certain cancers.
"The healthcare system in this country is fundamentally broken, with millions of patients denied the care they need due to profit-driven practices," said Wendell Potter, Claimable advisor, health insurance reform expert and former insurance executive. "Claimable offers a critical remedy. This platform is a lifeline for those caught in the machinery of an industry that too often prioritizes dollars over lives."
The platform’s guided appeal builder offers smart document scanning, a dynamic health questionnaire, and instant evidence matching. Unlike static form-based tools, Claimable delivers a personalized experience that adapts to responses in real time. Each appeal generated features a compelling, fact-based narrative, tailored to the patient’s unique circumstances and story.
Claimable is now available nationwide and accepts denials from all insurance providers, including Medicare, Medicaid, United Healthcare, Anthem, Aetna, Cigna, and BCBS plans. Claimable submits appeals via Fax and First Class Mail, requesting urgent 72-hour reviews when appropriate. With affordability at its core, Claimable charges a fee of $39.95 per appeal, plus shipping.
For more information about Claimable or to join the waitlist for future conditions, visit www.getclaimable.com.
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About Claimable:
Claimable is revolutionizing the way patients fight healthcare denials, helping ensure everyone has access to the care they need and the coverage they deserve. The platform leverages custom-built AI to analyze clinical research, policy details, appeals data, and patients’ unique medical stories, generating and submitting customized appeals in minutes. Claimable is available nationwide, accepting denials from all insurance providers, including Medicare and Medicaid. As an NVIDIA Inception Program member, Claimable continues to push the boundaries of AI innovation in healthcare. For more information visit https://www.getclaimable.com/.
Contact:
Emily Fox
press@getclaimable.com
Your denied healthcare claims, handled. Introducing Claimable's AI-powered platform that helps patients challenge unjust denials with custom appeal in minutes.
At Claimable, we believe everyone is entitled to the care they need and coverage they deserve. Our physician-led team of healthcare insiders, data scientists and technologists is dedicated to fighting back against the 850 million denied U.S. health claims each year, challenging baseless denials and removing barriers to care, financial strain, and medical debt.
Introducing Claimable's AI-Powered Platform
Our AI-powered platform analyzes clinical research, policy details, appeals data and your unique medical story to generate and submit customized appeals in minutes.
"This platform is a lifeline for those caught in the machinery of an industry that too often prioritizes dollars over lives."
–Wendell Potter, health insurance reform expert and former insurance executive
Using Claimable is like having your very own team of AI-powered experts:
Analyzer
We extract relevant details from your documents and plan policies so you don’t have to, and transform them into compelling facts and powerful stories.
Researcher
We instantly search millions of clinical guidelines, appeal precedents, policy details and legal frameworks to find evidence that supports your claim.
Strategist
We gather, review, and apply learnings from winning appeals similar to yours, ensuring you have the strongest strategy possible.
Wordsmith
We create your appeal in minutes, using our proprietary algorithm to maximize the strength of arguments, evidence, tone, voice and style.
Assistant
We help you reach the right decision-makers by taking care of letter delivery and tracking, and offer guides, reminders and tips for following up.
Breaking down your winning appeal
Claimable is your secret weapon, blending advanced technology, insider knowledge, and a library of evidence to craft customized appeals that get results.
We pull information from three important categories to craft a comprehensive, compelling appeal.
Personal Impact
Your story matters. We summarize facts, events and the personal impact of denied care on your health, life and finances.
Clinical Evidence
We illustrate the clinical justification for care, pulling from medical studies, established guidelines, claims and appeals precedents.
Policy Compliance
We include plan policies and local laws relevant to your case, demanding insurers provide specific decision details and a fair, fast appeal review.
Getting started
Our appeal builder makes the process painless, we promise. Here's what to expect:
- Eligibility check - While we are working hard to support all types of care and conditions, we currently support autoimmune and migraine related denials within the last 180 days. As a first step, we will review your denial details and let you know If Claimable can help.
- Easy document upload - You’ll start by snapping a photo of your insurance information and denial notice. This helps us save you time and ensures we don’t miss anything. No documents, no problem – you can share details manually.
- Medical history questionnaire - We'll ask you a few simple questions about the events leading up to the denial. To prepare, be ready to share what alternative treatments you’ve tried in the past and why your doctor prescribed the treatment.
- Optional extras - In some cases, sharing a statement of medical necessity from your doctor or other documentation may strengthen or expedite your case. These aren’t required, and we’ll explain how to obtain extras if you don’t have them.
You can pick up where you left off anytime and your information will be saved.
Getting a fast and fair response
Once your appeal is created, we don’t stop there. We send your appeal by Fax and First Class Mail with tracking to make sure it’s received. We request urgent, 72-hour reviews when appropriate, and typically receive standard appeal decisions within a couple weeks. In addition, we hold insurers accountable to Affordable Care Act and ERISA regulations that mandate who reviews your appeal, what they share about their decision, when they share it and how they share it.
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Support when you need it
We provide guidance, reminders and tips to help you take action with confidence, and offer expert support when you need it.
- Reminders and tips - Throughout the process, we offer step-by-step guidance to capture your personal story, review your draft appeal, reach the right decision-makers and follow up with insurers.
- Knowledge resources - Get answers for commonly asked questions, understand your appeal rights and process, and decode confusing terms and codes.
- Support when you need it - Our appeals team is available when you have questions, want clarifications or need extra support. We respond to support needs within 1-3 business days via email and offer live support when needed.
Getting it all at a fair, flat and affordable price
We don’t take percentage-based fees because we believe getting access to the care you need and coverage you deserve shouldn’t cost you a fortune. Instead, Claimable’s AI-powered platform delivers a powerful, efficient, affordable appeals, without having to pay thousands for a lawyer or professional advocate.
Featured stories
Download a winning sample appeal
Want to see what it takes to successfully overturn a health insurance denial? Download our sample appeal to learn how we build strong, evidence-based cases that get results.
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Each month, I endure about eight major episodes, each one leaving me exhausted, unable to concentrate, and too unwell to take part in daily life.
The frequency and unpredictability of these symptoms have isolated me socially and limited my capacity to take part in activities most people take for granted.
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One of our core principles is to help patients protect their rights and level the playing field with their insurance company. This includes rights to multiple appeals, fair reviews, decision rationale, exceptions when needed, and adequate network access, among others. For more, read our post on patients rights.
Claimable’s AI-powered platform analyzes millions of data points from clinical research, appeal precedents, policy details, and your personal medical story to generate a customized appeals in minutes. This personalized approach sets Claimable apart, combining proprietary and public data, advanced analysis and your unique circumstances to deliver fast, affordable, and successful results.
We currently support appeals for over 85 life-changing treatments. Denial reasons may vary from medical necessity to out of network, and we even cover special situation like appealing plans that won’t count your copay assistance towards your deductible (hint: those policies were banned at the federal level in 2023). That said, we are rapidly growing our list of supported conditions, treatments and reasons. You can quickly check eligibility and ask to be notified when your interest becomes available. It helps us know where to focus next 🙂
We think about appeal times in a few ways. First, many professional advocates and experienced patients spend 15, 30 or even 100 hours building an appeal–but with Claimable, this takes minutes. We automate the process of analyzing, researching, strategizing and wordsmithing appeals. Next, there is the process of figuring out where you will send it (hint: expand your reach beyond appeal departments), then printing, mailing and/or faxing your submission. We handle that, too. Finally, there is the time it takes to get a decision. We request urgent reviews when appropriate, and typically receive standard appeal decisions within a couple weeks.
Review periods are mandated by applicable laws, from 72 hours for urgent, 7 days for experimental, 30 days for upcoming and 60 days for received services. Our goal is to get a response as fast as possible, since most of our clients are experiencing long care delays or extreme pain and suffering.
Claims are denied for a variety of reasons, many of which blur definitions. We focus on helping people challenge denials by proving care is needed and meets clinical standards, in addition to addressing specific issues like experimental treatments, network adequacy, formulary or site of care preference exceptions. We don't support denials for administrative errors or missing information, as we think those are best handled by simply resubmitting the claim in partnership with your provider. That said, many of our most rewarding successes have been cases previously though 'unwinnable', with providers and patients who fought tirelessly for months without appropriate response or resolution.
A denial letter is a formal notice from your insurance company explaining why a claim was denied and how you can appeal the decision. Sometimes the notice is included within an Explanation of Benefits. It is a legal requirements; if you didn’t receive one, contact your insurance company.
A letter of medical necessity is a statement from your doctor justifying why a specific treatment is critical to your care and/or urgently needed. You can attach it to your patient appeal to strengthen your case, especially if you are requesting an urgent appeal or need to skip standard ‘step therapy’ requirements. That said, we don’t require them and are often successful without them.
A claim file contains all the documents and communications your health plan used to decide whether to approve or deny your claim. Most health plans are legally required to share this information upon request. According to a ProPublica investigation, reviewing your claim file can help expose mistakes or misconduct by your health plan, which can make your appeal stronger.
Your insurer is required by law to give you written information about how to appeal, including the name of the company that reviewed your claim and where to send your appeal. Your health insurer may work with other companies, such as Pharmacy Benefit Managers (PBMs), Third-Party Administrators (TPAs), or Specialty Pharmacies, to manage your claims. These companies might be responsible for denying your claim and handling the appeal process on behalf of your insurer.
If you don't win your first appeal– don't give up! Many people are successful on their 2nd, 3rd or even 4th try, and future appeals are reviewed by independent entities. That said, we wrote a whole guide to understanding your options, including escalating your appeal and seeking other assistance for covering costs, forgiving debt or even seeking legal or regulatory support.
While both denial rates and appeal success rates vary widely by the type of health plan, state, and insurance company, studies have shown more than 50% of people win their appeal–and we apply strategies to boost your chances of success. Claimable has an 80% appeal success rate. The biggest denial challenge is that most people never appeal–allowing unjust denials to control their healthcare options because they are unaware of their rights or lack the support needed to fight back. No one needs to fight alone–Claimable is here to help. We know first hand that many denials are based on errors, inconsistencies or auto-decisions, and have proven strategies for fighting back against this injustice.
Let’s get you covered.