AI Takes on Insurance Denials: How Doctors Are Fighting Back with Technology

The Fight Against Insurance Denials: A New AI Tool for Physicians

Primary care physicians like Dr. Paul Abramson in San Francisco face a common hurdle: insurance denials for medications or services their patients need. These denials often arrive via email or fax, forcing doctors to spend hours appealing by sifting through medical records and crafting precise letters to convince insurers to reconsider. The process is exhausting by design.

Insurance companies reject about 1 in 7 claims, yet doctors and patients appeal less than 1% of those denials. When they do appeal, they win most of the time. This gap shows how many give up due to the workload and frustration involved.

Dr. Abramson has recently tested an AI tool that generates appeal letters, helping him save time and energy while improving approval rates for his patients. He describes it as an “arms race” — insurers use technology to delay and deny care, so now doctors are using technology to fight back with better documentation.

The Emergence of Fight Paperwork

Fight Paperwork is a professional AI platform built on the foundation of Fight Health Insurance, a patient-focused appeals tool created by San Francisco engineer Holden Karau. After leaving her job at Netflix, Karau dedicated herself to helping physicians and patients stand up to insurance companies.

Fight Paperwork helps doctors “bite back” by automating much of the tedious appeal process. Dr. Leah Spieler, a primary care physician in Emeryville, credits it and similar AI tools for saving hours weekly and freeing mental bandwidth to focus on patient care. “I didn’t go to medical school to spend my time figuring out the exact words that will get insurance companies to approve medications,” she said.

Since its May launch, Fight Paperwork has processed over 6,000 appeals. In some cases, doctors have used it to handle more than a dozen denials daily or reduce insurance charges drastically—from $1,000 to $20. The company charges a monthly fee and is actively marketing to reach more providers, especially mental health therapists who often work solo and lack administrative support.

The Unequal Battle Against Insurance Companies

Though AI tools help doctors and patients fight insurance denials, the battle remains uneven. Dr. Harley Schultz, a retired Bay Area physician, notes that insurance companies have far greater resources, making this “arms race” more of a minor annoyance for them than a real threat.

He expects insurers to respond with their own automation, creating a cycle where “their robot basically wrestles with your robot.” Schultz argues that if insurers truly aimed to provide the best care at the lowest cost, they would use AI to identify unusual care requests for review rather than issuing broad denials.

Dr. Abramson agrees that regulation is necessary to fix the problem. Currently, insurers face no real consequences for wasting doctors’ and patients’ time. California is considering legislation to increase transparency around pharmacy benefits managers, middlemen accused of driving up prices. Still, doctors like Abramson find it difficult to engage with lawmakers directly.

For now, tools like Fight Paperwork offer a manageable way for physicians to invest their time and energy in advocating for their patients and pushing back against an inefficient system.

For insurance professionals interested in AI tools and automation in healthcare, exploring automation courses can provide valuable insights into how technology is shaping this ongoing struggle.