Patients Are Using AI to Appeal Denied Insurance Claims and It's Working
Most denied claims go unchallenged. AI tools are starting to change that.
If you've ever had a health insurance claim denied and then looked at the appeals process and thought, "I don't have the time or energy for this" then you're in good company. A recent PBS NewsHour report found that nearly 20% of ACA claims are denied, yet fewer than 1% of patients appeal. The paperwork is confusing, the process is exhausting, and most people simply give up.
A growing number of patients are now using AI tools to push back. Software companies have built services that take your documentation, review the specifics of your denial, and generate a detailed, customized appeal letter. The typical cost is $40 to $50, and early reports suggest the results are promising.
There's important context here worth knowing. Insurers themselves are already using AI to process and deny claims. A surprising 71% of health insurers surveyed in 2025 acknowledged using AI for coverage decisions, according to the National Association of Insurance Commissioners. Some denial letters now say outright that an AI program reviewed the claim. So this is less about AI entering the picture and more about patients gaining access to the same kind of tool insurers have been using for a while. The regulatory landscape is still catching up, and experts note that meaningful oversight is still limited. But for anyone sitting on an uncontested denial right now, it's a practical option worth knowing about.
Have you used AI to assist with health insurance tasks?