Introduction

In a bold move to tackle the burgeoning problem of insurance claim denials, Warris Bokhari has launched Claimable, an innovative startup that utilizes cutting-edge AI technology. With a staggering 85% success rate in reversing claim denials, the platform aims to ease the anxiety many Americans face regarding their healthcare access.

Background

Bokhari, who previously worked in the insurance sector, identified denial of care as a significant hurdle within the U.S. healthcare system. "It's no wonder why people give up," he stated. "If you're a rational person, you would say this model is not fit for purpose." His deep understanding of the challenges associated with insurance claims propelled him to create an AI-driven solution that seeks to empower patients instead of frightening them away from seeking essential medical help.

Personal Journey

Raised in the UK with two disabled parents, Bokhari contrasts his experiences with the U.S. healthcare system. In the UK, he encountered a healthcare framework where necessary treatments weren’t denied. After migrating to America, he worked as an ICU doctor and spent two years at Anthem, Inc., where he witnessed firsthand the complexities and frustrations patients endure when dealing with insurance companies, which often obstruct necessary care.

Industry Context

The recent tragic event involving the fatal shooting of UnitedHealthcare CEO Brian Thompson has added a layer of scrutiny on the industry. While the motives are still under investigation, many voices in the public domain have voiced their frustrations with health insurers. Bokhari condemned the violence, stressing, “That is not the productive solution. The productive solution is appealing.”

The Problem of Denials

Data showcases the magnitude of the issue: denial rates have been on the rise for over a decade, with KFF reporting that 17% of in-network claims from HealthCare.gov insurers were denied in 2021. Despite the potential for appeals, less than 1% of all denied claims are pursued, highlighting the perilous situation many patients find themselves in when seeking recourse.

Claimable's Solution

Claimable has gained momentum in the health tech space as it supports appeals for over 50 FDA-approved treatments, particularly focusing on those for autoimmune and migraine conditions. The platform’s design allows patients to narrate their healthcare journeys, and its intelligent AI quickly analyzes extensive data to generate tailored appeals. With a fee of just $39.95 (plus shipping) for each appeal, Claimable aims to remove barriers to fighting insurance denials.

Regulatory Accountability

In addition to filing appeals with insurance companies, Claimable provides copies to relevant regulatory bodies to ensure accountability. Bokhari believes that regulators often overlook the continuous struggles of patients facing denial, saying, “They make big headlines, but they don't know that these very private tragedies happen every day in American life.”

Funding and Growth

Claimable recently closed its seed funding round in March 2024, receiving backing from notable investors like Walkabout VC and Humanrace Capital. Additionally, the startup is part of Nvidia's startup program and currently operates with a dedicated team of around 11 employees.

Conclusion

As Claimable continues to grow, Bokhari remains dedicated to transforming patient experiences, making sure that their voices are heard and their rights to necessary care are defended. In a healthcare landscape fraught with fear, innovation like Bokhari’s promises to bring clarity, hope, and a sense of empowerment back to patients.