Remi Lee was born with “medical stuff.” She has caudal regression syndrome, a condition that affects the development of the lower part of a child’s body. It affects one to two out of every 100,000 newborns worldwide.
In a mini-documentary for The News Movement (TNM) published on April 18, Lee revealed she “needs a lot of help to continue going.” She has only one kidney, no calf muscles, her ovaries didn’t develop properly and her feet had to be rebuilt when she was a baby.
She is constantly in need of care and relies on a lot of medication, equipment and frequent hospitalizations. But her experience with health insurance has been a “profoundly not positive one,” she told TNM. “They deny and deny and deny.”
Don’t miss
- I’m 49 years old and have nothing saved for retirement — what should I do? Don’t panic. Here are 5 of the easiest ways you can catch up (and fast)
- You’re probably already overpaying for this 1 ‘must-have’ expense — and thanks to Trump’s tariffs, your monthly bill could soar even higher. Here’s how 2 minutes can protect your wallet right now
- Gain potential quarterly income through this $1B private real estate fund — even if you’re not a millionaire. Here’s how to get started with as little as $10
Lee described an incident when her insurance company denied wound care supplies as a “luxury.” But, from a young age, she began learning from her mother how to fight the denials.
“If we get a denial and we turn in an appeal, almost every single time it’s, like, ‘Oh, okay, yes this is really needed,’” Lee’s mother, Roxanne, told TNM. “But because it doesn’t fit in the normal parameters, the system has an automatic, ‘No we won’t cover that.’”
Are insurance companies harnessing AI?
Lee noted her claim denials now appear to happen at a faster speed, which she suspected was due to the use of artificial intelligence (AI).
“It’s like an automatic rejection of your appeal now,” she said.
TNM says it reached out to Cigna, Humana and UnitedHealth Group for comment. UnitedHealth stated that “claims that we use an AI algorithm to automatically deny claims are false.” Cigna stated that “we do not use AI to deny care or claims.” Humana did not respond.
But not everyone believes such claims from health insurance companies. Ryan Clarkson, founder and managing partner of Clarkson Law Firm, told TNM his firm has three major class-action cases proceeding against large health insurance companies for allegedly using AI and algorithms in place of licensed physicians in the claims process.
According to Clarkson, the insurer in one of those cases denied about 300,000 claims over a two-month period. During that time, he said it was calculated the company would have had about 1.2 seconds to review each claim, “and no reasonable person could ever conclude that 1.2 seconds is sufficient time to evaluate a medical insurance claim.”
Read more: Want an extra $1,300,000 when you retire? Dave Ramsey says this 7-step plan ‘works every single time’ to kill debt, get rich in America — and that ‘anyone’ can do it
The idea of using AI for processing claim denials isn’t new. In March 2023, STAT reported that AI was “driving denials to new heights in Medicare Advantage, the taxpayer-funded alternative to traditional Medicare that covers more than 31 million people.”
Concern around this topic was enough for the Centers for Medicare & Medical Services to send a memo in February 2024 to Medicare Advantage insurers clarifying that AI can’t be used this way, according to Ars Technica. Additionally, multiple states are looking at ways to regulate the use of AI in health insurance.
Patients can use the power of AI
In the meantime, some patients are taking it upon themselves to fight against claim denials. And they’re using AI to do it.
Holden Karau is the co-founder of Fight Health Insurance, a website that helps Americans appeal health insurance claims. That includes using AI to help generate health insurance appeals. Patients can upload their claim denial and in return receive a targeted appeal.
Karau built the tool after facing her own struggles with health insurance companies. At the time she spoke with TNM, she said the site had been used 3,546 times, and she had seen denials ranging from a few hundred dollars to what she estimated could be hundreds of thousands of dollars.
Karau told The San Francisco Standard that, while she doesn’t think health insurance companies will stop denying the big things, maybe making appeals more accessible will stop them from denying so many small things.
As Lee pointed out in her interview with TNM, why shouldn’t the average person fight fire with fire?
“If they’re doing it, we should also have that tool.”
What to read next
- Don’t have the cash to pay Uncle Sam in 2025? You may already be eligible for a ‘streamlined’ handshake with the IRS — here’s how it works and how it can potentially save you thousands
- Robert Kiyosaki warns of a ‘Greater Depression’ coming to the US — with millions of Americans going poor. But he says these 2 ‘easy-money’ assets will bring in ‘great wealth’. How to get in now
- Here are 5 ‘must have’ items that Americans (almost) always overpay for — and very quickly regret. How many are hurting you?
This article provides information only and should not be construed as advice. It is provided without warranty of any kind.
