Here’s something your health insurer doesn’t advertise.
An investigation found one major insurer’s AI algorithm was rejecting 90% of claims in under a second. Not after a doctor reviewed anything. Not after anyone read your file. One second. The physician overseeing those rejections spent an average of 1.2 seconds per case. Rubber stamp.
This has become industry-wide. AI auto-denial is the standard. And most people just accept the letter, feel defeated and stop there.
♟️ There is a way to fight back
Most people have never heard of a federal process called an Independent Medical Review. If your insurer denies a claim, you have the legal right to an external review by a doctor they don’t pay. Insurers reverse their own denials in those reviews far more often than they’d like you to know.
AI can help you write the appeal. Open ChatGPT, Claude, Gemini or Grok and paste this:
You are a patient advocate and health care attorney specializing in insurance appeals. My insurer denied my claim for [describe the treatment]. The denial reason given was: [paste exact denial language]. My diagnosis is [your diagnosis]. (1) Identify specific grounds for a medical necessity appeal, (2) Write a formal appeal letter citing the insurer’s own clinical criteria, (3) Tell me exactly what documentation my doctor needs to include and (4) Draft a request for an Independent Medical Review if the internal appeal fails.
🔒 Do this before you need it
Call the member services number on your insurance card right now and ask: “What is your process for requesting an independent external review?” Write down the answer. Having it before a denial changes everything.
That’s your health. Don’t let an algorithm be the last word.Your move this week: Pull out your last Explanation of Benefits. If anything was denied, even partially, paste it into that prompt. You may have money sitting there.
👉 Know someone fighting an insurance denial? Forward this before they give up. This prompt could get their money back.