In a recent interview on the Working Healthcare podcast, host Sheri sat down with healthcare advocate and expert Meredith Hirsch to discuss one of the most frustrating issues patients face today—insurance claim denials. With nearly 99% of denied claims never appealed, Hirsch sheds light on why this happens and how a new tech solution called Claimable is revolutionizing the appeals process.
A Startling Statistic
According to Hirsch, approximately 40% of health insurance claims are denied. Even more troubling, nearly all of these denials go unchallenged. Why? In many cases, it’s due to simple issues like incorrect medical coding or a misunderstanding around pre-authorizations. But whether it’s the patient or the medical practice, most parties either don’t know how to appeal or lack the time and resources to do so.
“It’s really unbelievable,” Hirsch noted, emphasizing the systemic nature of the problem.
Enter Claimable: A New Solution with a 90% Success Rate
Claimable, an AI-powered tool created by Dr. Wase Karim—an anesthesiologist with a strong background in tech—is turning heads in the healthcare world. Rather than continuing to practice medicine, Dr. Karim chose to make a broader impact by tackling insurance denials from the inside out.
Claimable uses artificial intelligence to assist in appealing insurance denials with an impressive 90% success rate. Initially focusing on rheumatology due to personal ties—Dr. Karim’s mother passed away from complications related to rheumatoid arthritis—Claimable is expanding its scope to support patients managing conditions like diabetes and obesity.
“He’s developed algorithms that consider everything from CPT coding to state and national regulations,” Hirsch explained. “Claimable even automates communication with insurers, executives, and legislators when necessary.”
Safe, Smart, and Affordable
Though AI can still seem intimidating to some, especially older Americans, Hirsch assures listeners that Claimable’s technology is safe and specifically designed to serve patients. It’s not a subscription-based model either. Instead, it operates on a one-time cost of just $50 per appeal—a small price to pay for peace of mind and potentially thousands in medical coverage.
Medical practices can upload patient records directly to the platform, and a secure link is then sent to the patient to initiate the appeal. “Honestly, many of us in healthcare would gladly pay the $50 ourselves,” Hirsch added. “The time and complexity involved in manual appeals make this solution more than worthwhile.”
Final Advice for Patients
When asked what advice she’d offer patients navigating insurance and healthcare claims, Hirsch didn’t hesitate.
“Once you hit 65, stick with Medicare,” she advised. “Avoid Medicare Advantage plans, which can complicate coverage and increase the likelihood of denials.”
She also urged people to thoroughly research insurance providers and plans, know what’s covered, and most importantly—don’t be afraid to fight back when a claim is denied.
Get in Touch
To learn more about Meredith Hirsch or tune into her insights, you can listen to the Working Healthcare podcast on Apple, Spotify, or your preferred platform. You can also connect with her directly via LinkedIn or visit her website at meredithhirsch.com.