"Still, she spent almost two years working to get the bill canceled, and in the end, only found rescue in an AI bot. In a statement, Anthem said it could not comment on Gonzalves' billing for privacy reasons. The free conversational bot Gonzalves, 39, used for help in defending the insurance coverage for her son's care in the hospital nursery identified a federal law and other information that supported her claim."
"The situation may be unsurprising for many of those with health insurance. Health care consultancy Premier pegged the national medical claims denial rate at 15% in 2023, while independent research group KFF found insurers that sell policies under the Affordable Care Act denied one in five claims that year. Gonzalves, however, had an advantage over many policyholders: She has a doctorate in a medical field and has worked for large health care companies for years as a clinician and scientist."
Anthem sought $1,800 from Lauren Gonzalves for hospital nursery services two years after her son's birth, despite her having met her out-of-pocket maximum and believing the policy covered the care. National denial rates were high: Premier estimated a 15% denial rate in 2023 and KFF found ACA insurers denied one in five claims. Gonzalves, who holds a doctorate and has worked in health care, spent nearly two years contesting the bill before using a free conversational AI bot that identified a supporting federal law and other evidence. Counterforce provides the bot and free AI-generated appeal letters after its co-founder experienced denials for his wife's cancer care.
Read at www.mercurynews.com
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