AI Emerges as a Powerful Tool in Battling Health Insurance Claim Denials

A Life on the Line and $250K in Medical Debt Amid Insurer Denials

The diagnosis came just as Nathan Kirkland and his wife were preparing for the birth of their second child in April 2024. Tests showed Kirkland, then 35 years, had intrahepatic cholangiocarcinoma, a rare form of cancer that develops in parts of the bile ducts housed within the liver. Kirkland's only chance for a cure was a liver transplant, but his tumor was too large to meet the criteria for the surgery. "Cholangiocarcinoma just isn't a cancer most people come out on the other side of," Kirkland told Medscape Medical News. "The doctor said to me, 'Don't plan on seeing your daughter born in a few short months.'" Devastated, but determined to fight, Kirkland started a chemotherapy regimen that month to help shrink the tumor. To improve his chances for a liver transplant, his oncology team also recommended a noninvasive procedure, known as a histotripsy, that uses high-intensity sound waves to precisely target and eliminate liver tumors while avoiding the complications of surgery or radiation. The technique, which the FDA authorized in 2023, has shown a 95% success rate for treating liver lesions. Despite the data and FDA authorization, Kirkland's insurer, Anthem Blue Cross Blue Shield, denied a prior authorization request for the procedure in May. In July, Anthem approved a subsequent request, and Kirkland had his first histotripsy later that month. But this approval shift did not indicate better times ahead for Kirkland. The opposite. Starting in early August, Anthem denied approval for Kirkland's two subsequent histotripsy procedures, calling the procedure "not medically necessary," and, in November, reversed its July approval because of a coding issue. Anthem's medical policy considers histotripsy an "experimental or investigational treatment for liver cancer," Janey Kiryluik, staff vice president for corporate communications at Anthem's parent company Elevance Health, told Medscape Medical News in a statement. After numerous appeals in the fall of 2024, the insurer upheld its decision not to cover Kirkland's histotripsy procedures. Without coverage, the three procedures cost about $150,000 out of pocket, according to Kirkland. Although the exact frequency remains hard to pin down, coverage denials have become increasingly common among major health insurers, like Anthem, and the rise appears to be fueled, in part, by insurers' use of artificial intelligence (AI) algorithms to review prior authorization requests and then deny claims in batches. In some cases, rates of denials may be 16 times higher when reviewed by AI tools than by humans, according to figures from a recent American Medical Association report. While most denials are ultimately overturned, that can take days, sometimes weeks or months, and delay life-saving cancer care. In a 2024 survey of radiation oncologists, for instance, 30% reported that the prior authorization process harmed their patients, and 7% said it led or contributed to a patient's death. "Every time insurers create a delay or a hurdle, it potentially complicates care," said Kirkland's Oncologist, Laura Tenner, MD, MPH, an associate professor in the Division of Oncology and Hematology at the University of Nebraska Medical Center, Omaha, Nebraska. "There have been some significant delays in prior authorizations and coverage by insurance companies that have delayed care to the point where patients missed out on curative intensive therapy for cancers." To limit the delays, patients like Kirkland may be left with an impossible choice: Find a way to pay for their care and potentially fall into deep debt or delay their care while fighting the insurance company. Kirkland couldn't wait. In October and November 2024, he underwent two more histotripsies. To cover the cost, Kirkland and his wife exhausted their children's college funds and borrowed money from friends and family. In January 2025, Kirkland received some encouraging news: The procedures, plus the chemotherapy, had killed off enough of his cancer for his medical team to approve him for a liver transplant. "I was on cloud nine once I got the good news from being cleared for transplant," Kirkland said. "I thought 'This is the best news ever! I'm going to be there for my kids.'" Kirkland started the transplant testing process. His brother agreed to be his donor, and a transplant date was tentatively set for February 14. But those plans halted abruptly. The family received a letter from Anthem denying coverage for the transplant. In the letter, dated February 6, 2025, Anthem claimed that the requested transplant was "medically unnecessary." "Medical studies do not show that this surgery will improve your short- or long-term health," Anthem officials wrote in the letter, which Kirkland shared with Medscape Medical News. "It was a gut punch," Kirkland said. "This can't be real." Desperate to get the care he needed, Kirkland and his family turned to social media. By this point, Kirkland's out-of-pocket costs totaled about $250,000. Within days of sharing his story, Kirkland's posts on Facebook and LinkedIn garnered more than 6000 shares. The LinkedIn post even caught the attention of billionaire Mark Cuban who offered to help pay for the transplant. But it was a new AI startup called Claimable that turned the tables for Kirkland's insurance fight. The company, which launched in October 2024, is one of a growing crop of AI-based companies using the technology to help patients and providers analyze health insurance claim denials, uncover issues, and ultimately appeal and overturn denials. Health policy analysts say the new wave of companies is part of a growing "battle of the bots" as health insurers increasingly use AI to deny claims. "It's not surprising that new AI companies have sprung up," said Michelle M. Mello, JD, a health law scholar at Stanford Law School who researches the effects of law and regulation on healthcare delivery. "On the provider side, there are more denials than people to process them, and one of the things AI tools can do is help figure out which denials are most likely to be overturned if appealed. Often, the reason something is denied is just that information is missing. So having AI systems in place that can figure out, can learn, and can put in that additional information, that seems really valuable." Claimable does not specialize in cancer cases, but when the company caught wind of Kirkland's story through social media, Warris Bokhari, MD, a former National Health Service physician behind the company, wanted to help. "We probably spent a couple of hours on the phone with Nathan and then spent the rest of the day working with his brother and his sister to piece together the story," said Bokhari, who previously led healthcare strategy and innovation across corporate America, including Anthem. "We went through every test, every imaging result. We went through all of the evidence. And over the course of the day, we basically put together an appeal that was then elevated to visibility at the insurance company." Bokhari discovered that Anthem had Kirkland's diagnosis wrong on the liver transplant denial. And it wasn't the first time. Anthem had initially misidentified Kirkland's cancer as neuroendocrine cancer, not intrahepatic cholangiocarcinoma, in a previous histotripsy denial. Although the original denial letters and initial appeal letter referred to liver cancer, Kiryluik told Medscape Medical News that the "'neuroendocrine cancer' term was inadvertently inserted by a medical director reviewer from a drop-down screen in place of 'liver cancer' which appears immediately above on the drop-down screen." But "this error did not impact the decision," Kiryluik wrote. The second time occurred in the transplant denial letter from February 6, which listed Kirkland's cancer as hilar primary sclerosing cholangiocarcinoma -- also a form of bile duct cancer, but one that develops outside the liver. The crux of Kirkland's appeal, however, was that Anthem was using data from 2004 to support its denial, Bokhari said. This is not unusual. Bokhari has found that many insurance companies rely on poor or out-of-date evidence or inconsistent enforcement of policies to make claim decisions. To unearth such issues, Claimable's AI platform analyzes patients' medical cases alongside clinical evidence, policy details, and appeal precedents in similar cases. The company charges patients about $50 fee for the service. In Kirkland's case, Claimable pointed to studies starting in 2018 that showed outcomes for patients with cholangiocarcinoma drastically improved following neoadjuvant chemotherapy and a liver transplant. The 5-year survival rate was close to 60%, according to a recent study. "That was significant," he said. "And ultimately, our involvement was really to show that this should be a clinical decision between the transplant surgeon and Nathan." Bokhari said it's unclear if Anthem used AI in Kirkland's claim denials -- he becomes suspicious when denials include errors and incorrect terms -- but the denials could have also been based on "incompetent review," he added. Anthem denies using AI in its coverage decisions. "AI is not used in denial decisions," Kiryluik told Medscape Medical News. "Denial decisions are made by an appropriate medical director through our peer clinician review process." Claimable sits alongside a small but growing number of companies using AI to help physicians and patients fight health coverage denials. In June 2024, Flight Health Insurance launched a platform to help patients appeal denials and, in April 2025, expanded its reach to providers with a platform called Fight Paperwork. In November 2024, Cofactor AI introduced an AI-powered platform called Cofactor Denial Suite that supports claim appeals for providers. In January 2025, payment software company Waystar announced the launch of Waystar AltitudeAI™ to help providers appeal denied medical claims. And in April 2025, Red Sky Health unveiled its new AI-solution, Daniel, which helps providers identify and correct claims errors. Holden Karau, a software development engineer who created Flight Health Insurance, has been thinking about insurance coverage issues since being hit by a car in 2019. While the insurer paid for her "bones to be fixed," Karau said nearly every other aspect of the process ended in a payment dispute. Only recently has the technology gotten to a point where it made sense to work on a platform to help fight denials, Karau said. Like Claimable, Karau's company keeps the process simple and the costs low for patients and providers. "The hope is to keep the prices low because we think that there's just so many denials out there that aren't being appealed," Karau said. Six days after the February 6 transplant denial, Kirkland learned that Anthem had reversed its decision based on "new information." According to Bokhari, Claimable is currently beating about 85% of health coverage denials. Kiryluik told Medscape Medical News via email that the initial coverage request was "denied due to lack of medical necessity based on the provided information." "After Mr Kirkland contacted us on February 9, we initiated an appeal process, which included further discussions between our oncology medical director and his transplant surgeon," Kiryluik said in a statement. "It was during this review that new details were provided, including an updated diagnosis and data on the transplant center's success rates for patients with similar diagnosis," Kiryluik explained. Claimable's letter, for instance, corrected Kirkland's cancer diagnosis and cited data from Kirkland's transplant team showing that all 10 patients with intrahepatic cholangiocarcinoma who had received a liver transplant at their institution had survived. "With this new information, Anthem approved coverage for Mr Kirkland's liver transplant and informed him of the decision," Kiryluik said. But time was not on Kirkland's side. After Anthem reversed its denial, Kirkland's medical team immediately rescheduled his transplant. Physicians knew it was urgent he received his transplant before his cancer metastasized. Kirkland was prepped and headed into surgery on February 14, which he called "fitting" because the date happened to be National Organ Donor Day. Surgeons opened him up. Before the transplant, his team first wanted to biopsy a retroperitoneal lymph node. The biopsy came back positive for cancer, indicating the tumor had metastasized. Because the lymph node was outside the surgical resection field, Kirkland's cancer would not have been fully removed, even with a liver transplant, explained Tenner. The transplant procedure was cancelled. Kirkland and his family were crushed. A curative liver transplant is now off the table for Kirkland and the goal is to explore palliative therapies to extend his life and give him the best quality possible, Tenner said. His oncology team is also looking into clinical trials for him, she said. But there's a lingering question: Did Kirkland miss the slim window he may have had for curative intent therapy because Anthem's prior authorization process and coverage denials delayed his care? "There is a chance that had things been approved quicker and a biopsy obtained, the cancer would not have spread at that time, but I can't give you a definitive 'yes' or 'no' on that," Tenner said. Ultimately, Anthem also reversed its denials of Kirkland's histotripsy procedures after Claimable got involved. Kirkland also believes the social media attention surrounding his case contributed to Anthem's shift. But the insurer told Medscape Medical News that "Anthem approved coverage of the histotripsy following an external review by an independent peer review organization. Consideration was given to several factors, including the member's unique clinical circumstances and documentation by the treating facility that the member had exhausted all evidence-based therapies, and other alternative medical services were not available outside of a clinical trial." In late May, Kirkland finally received his first reimbursement check for $97,000 of the $250,000 he had paid. Even the reimbursement process was "slow and messy," he said. He is still waiting for the remaining amount, and his surgeon is still waiting to be paid by Anthem, he said. Despite his outcome, Kirkland said he's "not done fighting." He hopes his story will draw attention to unfair insurance denials and lead to changes in company policies. In February, he filed an ERISA appeal to Anthem, urging the insurer to make changes in its policies for patients who need liver transplants and FDA-backed histotripsy procedures. "At this stage, it's more about making sure other people get the opportunity and the care they need to have a better outcome," he said. "It shouldn't be such a burden to get treatment."

Heath Insurers Are Denying More Drug Claims, Data Shows

Sarah Kliff has covered medical billing and its impact on patients for more than a decade. Prescription drug denials by private insurers in the United States jumped 25 percent from 2016 to 2023, according to a new analysis of more than four billion claims, a practice that has contributed to rising public outrage about the nation's private health insurance system. The report, compiled for The New York Times by the medical data company Komodo Health, shows that denial rates rose from 18.3 percent to 22.9 percent. The rejections went up across many major health plans, including the country's largest private insurer, UnitedHealthcare. The data offers a rare look into the largely hidden world of rejected insurance claims. While some government-funded health plans are required to publish their denial rates, most private insurers keep that information confidential. Komodo draws from private databases that collect denial details from pharmacies, insurers and intermediaries. Claim denials are "quite opaque, and a lot of decisions are made by private actors," said Dr. Aaron Schwartz, a health economist at the University of Pennsylvania. "There are legitimate questions about whether they are appropriate." Widespread resentment toward health insurers boiled over last December after the murder of UnitedHealthcare's chief executive, Brian Thompson. Doctors and patients alike took to social media to share stories of insurers' refusal to pay for what they said was needed medical care. Experts who have studied denials said the skyrocketing costs of popular new weight loss medications and greater automation of the claims process with artificial intelligence may have contributed to the rising rejection rates. "The challenge for a lot of people accessing the health care system is that it is a morass of competing interests," said Arif Nathoo, Komodo's chief executive. "At the heart of it is a patient experience that is really suboptimal." The new analysis does not show what happens to patients after claims are denied. Often, insurance industry officials said, replacement claims for the same drug are eventually approved. It is unclear how many people end up forgoing their medicine altogether. Decisions to deny claims are not always made directly by health insurance plans. Much of that work is done by pharmacy benefit managers, middlemen who are contracted to manage prescription drug coverage. Large employers can also play a role, dictating which drugs they want covered for their workers in their provided health plans. AHIP, the insurance industry's lobbying group, laid some of the blame for denials on pharmacies, doctors and rising drug prices. "Health plans approve the vast majority of claims they receive, and spending on prescription drugs continues to escalate," said Chris Bond, a spokesman for the group. "However, providers or pharmacies sometimes submit duplicative, inaccurate or incomplete claims that can result in an initial denial -- a frustrating outcome for patients." Last month, major insurers that provide coverage to most Americans pledged to reform their use of a tactic known as prior authorization. It can lead to delays in care because it requires providers to get permission for a treatment before the insurer will cover it. Insurers said they would aim to make 80 percent of prior authorization decisions in real time by 2027 and reduce the use of the method overall. Prior authorization was responsible for about 10 percent of denied claims in the Komodo data. The analysis found that the most common reason for a drug claim to be rejected was that a refill had been requested "too soon," before the patient was eligible for more medication. "Appropriate prescription drug denials can happen for numerous reasons, and many can be resolved within minutes," said Greg Lopes, a spokesman for the Pharmacy Care Management Association, a trade group for pharmacy benefit managers. While UnitedHealthcare has been singled out by the public, the Komodo data shows that five of the largest private insurers have similar rejection rates, all of which have increased since 2016. (The rate of one insurer, Humana, dropped in the last two years of the analysis.) UnitedHealthcare declined to comment on the new data. A spokesman, Eric Hausman, said in a statement that the company's own analysis of its denial data showed that most rejected claims were followed by a subsequent claim for the same drug that was approved. "By far the most common reason a prescription is not filled right away is the refill is being sought too soon by the pharmacy and does not affect the member experience," he said. Representatives for Aetna, Humana and Anthem declined to comment on the data. A Cigna spokeswoman did not respond to repeated requests for comment. The increase in denials is sharper in the private plans that Americans typically receive through their employers than it is in public insurers like Medicare and Medicaid, the Komodo analysis found. Private plans now have a slightly higher denial rate than traditional Medicare. The rate of rejected claims is still lower than Medicaid, which covers low-income Americans, and private Medicare Advantage plans. In a 2022 study, Dr. Schwartz of the University of Pennsylvania found a 15 percent increase in rejection rates by Medicare and private Medicare Advantage plans over a similar period, 2014 to 2019. A congressional investigation of those plans last year found that some had denied coverage for rehabilitative care to "boost profits." The increased denial rates across the industry could reflect years of insurers layering new restrictions on top of one another, Dr. Schwartz suggested. Pricey new GLP-1 weight loss drugs like Ozempic, and other blockbuster medications, may have led insurers to increase restrictions on other drugs as they grappled with ways to offset those growing costs. Michal Horny, a health economist at the University of Massachusetts, suggested the increased use of artificial intelligence to sort through claims might have also fueled the uptick in denials. "In 2016 no one would have attempted to use A.I. for anything," he said. "Now A.I. is lot more prevalent in business processes." It is difficult to track the effects of denials on patients, health economists say, because it requires linking insurer claims data with long-term medical records. But a handful of recent studies have found evidence of harm. One published in 2023 followed 2,495 cancer patients as their health plan instituted a new prior authorization policy, and compared them against a group with no such restriction. The cancer patients with prior authorization requirements were more likely to have a sudden interruption in access to their oral chemotherapy medication, the researchers found. They faced, on average, a nearly 10-day delay. "If you were already taking a drug for leukemia and then had interrupted access, we can view that as a bad outcome," said Michael Anne Kyle, a health economist at the University of Pennsylvania and the study's lead author. "You might think that it turned out fine but, for the person with cancer sitting there thinking 'I don't have the medications I need to live,' that feels terrible." A 2024 study by a team of Yale economists looked at a spike in drug denials for Medicaid recipients in Tennessee after the state brought in a private contractor to run the public health plan. In most cases, patients ended up filling a prescription for a cheaper, generic drug or similar medication, and it's unclear whether that had significant health effects. Jacob Wallace, who led the study, described a hypothetical case of a child who had been taking a long-acting medication to treat A.D.H.D. but was switched to a short-acting one. It's possible that could have detrimental effects, he said, but "we're unlikely to pick that up without being able to link to educational performance data. The big picture is hard to see." Some prescriptions without easy substitutions simply went unfilled, the study found. These included antibiotics and inhalers. Warris Bokhari found himself fighting an inhaler denial this year as wildfires raged in Los Angeles and the flames crept within 200 yards of his home. Worried that the air quality would aggravate his asthma, Mr. Bokhari tried twice to refill a prescription for an inhaler he had used for more than a decade. He had recently switched health plans and his new insurer, Aetna, denied coverage both times. His plan covered "several clinical alternatives," an Aetna spokesman, David Whitrap, later told The Times. But Mr. Bokhari had found that the prescribed medication worked better for him. So he paid $600 out of pocket, rationed his doses and relocated to a hotel until the fires subsided. Soon after, Mr. Bokhari got to work appealing the denials. He was perhaps uniquely qualified for the task. A former insurance executive at Anthem, he now runs a business that helps patients appeal denials. On March 4, he sent a 14-page letter to Aetna executives and California insurance regulators, citing academic studies and letters from his doctor to make the case that his inhalers were necessary and should be covered. The next day, the denials were reversed. The Aetna spokesman said it was a "courtesy exemption." Reed Abelson and Rebecca Robbins contributed reporting.

AI is helping patients fight insurance company denials: 'It is wild'

Stephanie Nixdorf's insurance company repeatedly declined to cover a drug to treat her arthritis. That changed after she sent an appeal letter crafted with help from AI. Stephanie Nixdorf was at Disney World with her family in December 2021 when she got the call. A mysterious bump on her elbow was melanoma, her doctor said. Tests later showed it was Stage 4, with spots on her lung and two tumors in her brain. Nixdorf, 51, a mother of four who lives with her husband, Jason, in Davidson, North Carolina, began treatments immediately, and by January 2024 her cancer was abating. The Premera Blue Cross health insurance offered by her husband's employer had covered her cancer care, but in early 2024, when Stephanie's doctors prescribed a drug to battle crippling arthritis induced by her immunotherapy treatments, the denials began. "I used to run, play tennis, be active," Nixdorf told NBC News. "Now I can't even open a yogurt or grip a steering wheel in the morning." Premera Blue Cross, a not-for-profit licensee of the Blue Cross Blue Shield Association in Mountlake Terrace, Washington, is a leading health plan in the Pacific Northwest, serving 2.5 million people. For nine months in 2024, it denied repeated requests by Nixdorf's doctors to cover infliximab, an inflammatory arthritis drug they'd prescribed. With his wife in agony, Jason Nixdorf had a chance encounter with Zach Veigulis, a former chief data scientist at the Department of Veterans Affairs who was co-founding a company to help patients battle insurance company denials. That company, Claimable Inc., built an AI platform that allows patients to generate customized appeal letters containing comprehensive assessments of clinical research on a drug or treatment and other patients' appeals history with it. The cost: around $40. When Nixdorf reached out, Claimable's site was not yet live, but its chief executive and co-founder, Dr. Warris Bokhari, offered to help write an appeal letter for Stephanie using they system they had developed. In mid-September 2024, she sent that 23-page appeal letter to Premera's chief executive and chief legal counsel, arguing that one of its own policies states it should cover infliximab, her records show. Her letter also went to the governor and attorney general of North Carolina, officials at the Department of Health and Human Services, the Consumer Financial Protection Bureau and the Wage and Hour Division of the Department of Labor. Two days later, Premera approved the drug. "I want to apologize that you have been waiting to receive treatment for nine months," the approval letter said. Nixdorf is one of a growing cohort of patients using artificial intelligence to battle health insurance denials. Several companies offer software programs that let patients create comprehensive appeal letters relatively quickly, with the help of AI. It scrapes the internet for every shred of evidence of drug efficacy and past appeals success in a fraction of the time it would take a human to do. Courtney Wallace, a Premera spokeswoman, provided a statement to NBC News on the Nixdorf case. "There was no intent to deny care," she said. Rather, Premera made a "processing error involving a misapplication of policy and assignment to an incorrect physician specialist." Premera "fell short" in this case, Wallace added. Research shows the arthritis Stephanie was experiencing, if untreated, can cause irreversible joint damage and significant disability. Jason Nixdorf said he's relieved that his wife was able to receive coverage for a treatment her doctors prescribed, but he also feels angry over the ordeal and its consequences. "Not only has the delay caused Stephanie permanent damage," he said, "it will be a lifelong thing for her to deal with this arthritis. If we had gotten the OK in January, it could have been knocked out and done then." As many patients and their doctors know, trying to gain insurance coverage for a drug or treatment can be a full-time and exasperating task. Comprehensive data on insurance company denials is unavailable, but a January 2025 study by KFF, a health policy research, polling and news organization, found that insurers participating in so-called marketplace plans under the Affordable Care Act denied 19% of in-network claims in 2023, the most recent year for which data is available. Fewer than 1% of consumers appealed the denials, the research found, and when they did, over half the denials -- 56% -- were upheld. In addition to the impact insurance company denials have on patients' health, they carry a financial cost. In a 2023 KFF survey, 39% of consumers who were having trouble paying their medical bills said denied claims contributed to their problems. Amid the fight over Premera's denials, the Nixdorfs and their doctors repeatedly tried to set up a case review by calling a toll-free number that was never answered by a human being, leaving messages that were not returned, faxing paper documents at Premera's request, and completing letters of medical necessity. Wallace, the Premera spokeswoman, agreed there had been "a breakdown in communication" in the Nixdorf case. "We're focusing on providing a better experience for providers," she added. Nixdorf's documents show Premera's first denial came in February when the insurer said infliximab was "not medically necessary" to treat her arthritis. A second denial in June characterized the drug as "investigational or experimental," even though it is recommended for inflammatory arthritis by the National Comprehensive Cancer Network Drugs and Biologics Compendium, a bible among oncologists. The third denial, in July, said infliximab was not Food and Drug Administration-approved. "They set the system up so people give up," Jason said. After the third denial, Jason requested Premera provide all the records relating to its decision. He and his wife became even more troubled when they received the materials, learning, for example, that the doctor used by Premera in what's known as a peer-to-peer review of the case was a specialist in internal medicine with no expertise in cancer or inflammatory arthritis. They also discovered the company contracted by Premera to do an independent review of their case -- AllMed Healthcare Management -- was led by Jeff Card, who had been director of clinical review operations at Premera for seven years until he joined AllMed in 2021, his LinkedIn biography says. Having his wife's case reviewed by a company overseen by a former Premera executive presented a conflict of interest, Nixdorf told NBC News. Premera's spokeswoman declined to respond to this criticism, saying "AllMed is accredited by both the National Committee for Quality Assurance and the Utilization Review Accreditation Commission." Premera's partnership with AllMed is "subject to rigorous oversight, including quarterly reviews and audits" by the insurer, Wallace said. AllMed did not return an email and a phone call seeking comment from the company and from Card. Veigulis of Claimable said the company's three co-founders, including Alicia Graham, wanted to understand why people who have access to health care don't receive it. Building their AI model that went live last October, they began with rheumatology and migraine and now cover over 50 life-changing treatments. Veigulis said roughly 1,000 denials have been overturned by patients using the Claimable model. "We see so many people who have met the eligibility criteria who pay their premiums on time that still can't access their health care," he said. "It is wild." Tabitha Lee is a former paramedic working in rheumatology at Wilmington Health in North Carolina. Since January, she has handled prior authorization and insurance denials for the roughly 100 patients who come in each day. Denials have ramped up recently, she said. "We've had a lot of patients on medication for years, stable and well-controlled, and insurances were denying them," Lee told NBC News. Instead, the insurers would suggest alternative drugs that were on their approved lists, or formularies, she said. This was causing trouble for patients, Lee added, because "changing patients' medications can cause adverse reactions." Lee said she had tried filing appeal letters for patients but it was time-consuming to compile the scientific and clinical testing data on each case. In February, at the suggestion of a rheumatologist and adjunct professor at the Duke School of Medicine, she began filing appeals using an AI-generated system created by Counterforce Health, a nonprofit founded by Neal K. Shah, a former hedge fund manager turned health care entrepreneur and advocate. Shah is also chief executive of CareYaya Health Technologies, a nonprofit that connects college students pursuing health care degrees with families seeking care for aging relatives. At no charge, Counterforce generates customized appeal letters based on a patient's insurance policy and the current record of successful appeals related to the drug or treatment in question. The letters also go to insurance regulators in the patients' states to alert them to the denials, which Shah said they may not be aware of. "Denials should be appealed, but we observe most people don't appeal because they are intimidated by whole thing," Shah said. His message to patients: "When you get a no, please take the next step -- you have rights." Lee said using the Counterforce software has helped her overturn denials. "I've gotten back approvals on the same day and the day after," Lee said. "It definitely limits the time we have to spend formulating each denial letter and allows me to work more on initial prior authorization and patient assistance."