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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.

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‍What's behind our platform? Artificial intelligence is our superpower.

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. And our work is never done.

As an NVIDIA Inception Program member, we continue to push the boundaries of AI innovation in healthcare.  AI is evolving rapidly, as are insurance policies and regulations, and we're constantly enhancing the experience so that you have access to the latest and greatest AI has to offer. 

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.

This is the incredible power of AI and how it gives you superhuman appeals powers, with just the click of a button.

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.

To prevent hallucinations, Claimable uses only verified data sources and cross-references information across multiple databases.

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? 

Unlike general-purpose AI models like ChatGPT, Claimable is specifically designed for medical legal appeals, making it far more effective and precise for your specific needs.

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.

When it comes to insurance appeals, we believe everyone is entitled to fast, affordable, effective support.

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.

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In this article, we'll help you understand the role of your doctor when appealing a denied healthcare claim, and learn how best to work together–including 7 types of information to share.

If you find yourself confused and frustrated by insurance claims and denials, you are not alone. I’m a doctor and a patient with a chronic condition. I even worked at an insurance company for a while. With all that experience under my belt, I still find the rules and processes illogical and infuriating. 

The most important thing to know is that you can appeal.
It’s your right!

In this article, we’re going to talk about the role of your doctor when appealing a denial, and how best to work together––including my top 7 topics to discuss. 

Do I need to involve my doctor in my appeal? 

You do not need your doctor’s involvement to appeal a denied healthcare claim. There’s no set playbook and it’s unlikely your doctor is an expert (they don’t teach these things in medical school). If and how you involve your doctor is a personal choice.

It’s important to know that appealing directly can be very effective. Many doctors don’t know this is an option, and don’t advise their patients to appeal as a result. . 

So what can your doctor do? 

Unsurprisingly, there isn’t one simple path for your doctor to take. If your doctor's office has a lot of support staff, they may call the insurer for you and try to iron out the problem. The insurer may have your doctor speak to one of their doctors. This is something called a peer-to-peer review (though these calls can be tough to coordinate with limited peer availability for certain specialties). 

Instead, your doctor might suggest you try another treatment or enroll in a Patient Assistance Program. 

Discuss the trade-offs of different treatment options in terms of benefits, risks, time and costs.

7 denial topics to discuss with your doctor

The insurer might need more information to determine if the drug is appropriate or cost-effective. Below is a list of 7 items to arm your doctor with:

#1 - Symptoms

Track the frequency and severity, and share your notes with your doctor. It’s helpful to have everything formally documented in your medical records. 

#2 - Impact

Explain the impact on your daily life if care is denied. For example, an inability to drive, perform your job as expected, or care for a loved one.

#3 - History

Many insurers have specific rules around what has to be tried before they will pay for certain medications. Make sure your doctor documents all other medications and treatments you’ve previously tried, and why they did not work for you. 

#4 - Denial Reason

If you get a letter from the insurer, it might include a term like “denied for medical necessity,” “treatment is deemed experimental,” or “excluded benefit.” Or, perhaps you’ve concluded a trial period and need to report results to renew your medication. Knowing the reason for the denial allows your doctor to focus their conversation on the right issue. 

#5 - Current Guidelines

Ask your doctor to double-check current guidelines and to document against them as much as possible. These are often the basis of the insurance company rules. 

#6 - You Rights

You might need to tell your doctor that under the Affordable Care Act, your right to appeal is protected. An insurer must give you a good-faith reason as to why they denied your care.  

#7 - Urgent Review

If your medical needs are urgent because you face severe harm to your physical health, you may qualify for the Insurer to review your case more rapidly - usually within 72 hours. Make sure your doctor is aware of this, if applicable.

Arming your doctor with these 7 types of information will help them advocate more effectively on your behalf.

If you’re appealing directly, your doctor can still help. 

Getting a letter from your doctor stating the medical necessity and urgency of your care could help your case. This “Letter of Medical Necessity” doesn’t have to be long, but should include the condition that’s being treated, the treatment required, the reason it’s needed, and what happens if it isn’t received. It should be signed, dated, and included in your appeal. 

Certain insurers may ask for seemingly random information from your doctor, such as the Tax ID number of the practice. In this case, reach out to your doctor and explain why you need this information. Your doctor wants you to get the care you need, and should gladly empower you to file an appeal. 

I don’t know how to appeal. Where do I begin? 

Appealing a denied healthcare claim can feel overwhelming, but don’t worry, Claimable makes it painless. Our AI-powered platform analyzes clinical research, policy details, appeals data, and your personal medical story to generate and submit customized appeals in minutes. Our Introducing, Claimable article has everything you need to know to get started. The same details you might provide to your doctor can serve as the basis for an impactful direct appeal.

Ultimately, the best advocate for your health is you.

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