Challenging health insurance denials and building evidence for systemic reform

We are a nonprofit that helps patients reverse health insurance denials with the assistance of artificial intelligence.

The Problem

Every day, people are denied vital access to care - not because they don't need it, but because an insurer said no.

The Crisis

A parent with a newborn in the NICU. A cancer patient awaiting radiation. A neighbor in debilitating pain. They're told they can appeal their denials, but few do.

The Strategy

Insurers benefit from people giving up. Wrongful denials save money - not by merit, but by attrition. The system is unjust, especially for those with the least capacity to fight.

The Recourse

When appeals are filed, they are often overturned, suggesting that many denials were never justified in the first place. Appeals work, but are difficult to access, and poorly understood. Individually they don't address root cause, but they hold collective power.

>200M

Denials Each Year

Across the United States

>17%

People Facing Denials

For care recommended by doctor

<1%

Denials Appealed

Most patients give up

>30%

Denials Overturned

When appealed

What We're Building

We're developing AI-powered tools to help patients access healthcare by reversing denials, building scalable support systems, and curating evidence for systemic reform.

Fight Inappropriate Denials

We help patients fight wrongful coverage denials. We prioritize support for those with urgent or dire medical situations, and those who are least well served by existing systems. Appeals work when they're actually filed.

async def get_query_augmentation(
  self, query_str: str, limit: int
) -> tuple[str, list[Citation]]:

  # Search vector DB
  ctx, cites = await self.vector_client.search(
    query_str, limit
  )

  return ctx, cites

ML for the Common Good

We develop machine learning systems to support our case work. We are committed to doing no harm, and to deploying responsibly. We only use human-in-the-loop systems, increasing efficiency of experts rather than replacing them.

External Appeal Overturn Rate

Alzheimer's Dementia

Evidence Building

In collaboration with those we serve, we are building a scalable evidence base to shine a light on the systemic harms and injustice caused by wrongful denials. We aim to use individual victories to drive systemic change.

Free Coverage Denial Support.

Our coverage denial support is a zero cost public service for patients. We work with you to prepare thorough, documented appeals to help you fight back against denials and get the coverage you need.

We use artificial intelligence to streamline our support, but are committed to using it in ways that are privacy focused and responsible. Our approach is about increasing the efficiency of experts rather than replacing them, keeping humans at the center of all we do. We never share your data, or send it to third parties without your explicit consent.

How It Works

Contact & Review

You reach out → we review context and request documentation

Assessment

We assess our ability to help with your specific situation

Appeal Support

We help you construct expert appeals, using our human-in-the-loop, AI-assisted pipeline that analyzes relevant medical records, regulations, and clinical policies

Fierce Advocacy

We are in your corner every step of the way. We help you stay on timeline, overcome admin barriers, join you on calls, and contact regulators when needed

Collective Impact

With your permission, we anonymize and aggregate your data to build collective power, help others, and push for an end to this systemic problem