The solution
When Lexi Klomhaus's new insurer denied coverage for the mental health program her doctor said was necessary, she had no idea how to fight it — most patients don't: in plans bought through Healthcare.gov in 2021, less than 1% of denied claims were appealed. A TikTok video pointed her to Fight Health Insurance, a free tool by software engineer Holden Karau; in about eight minutes it drafted the appeal letter she had found too daunting to start.
The mechanism is tuned to exactly where patients stall. You upload the denial letter; a step automatically strips personal information. The AI then infers what procedure was denied, what the diagnosis might be and why it's medically necessary — 'we'll use the AI system to guess,' Karau says — and after the patient confirms the details, generates several ways the appeal could be framed, letting the patient choose the one that matches their situation.
Karau built the tool after repeated denials of her own — as a transgender woman who had to advocate for coverage of specific procedures, after a motorcycle accident claim, and finally when her pet insurer denied anesthesia for her dog. Meeting many others with the same problem convinced her it was common; the tool attacks the drafting cost that keeps appeal rates near zero.
Why it worked
It attacks the real bottleneck: not ignorance that appeals exist but the drafting effort — the industry has made the process as complicated as possible.
Auto-removing personal information removes the privacy fear that would otherwise stop people pasting medical letters into a tool.
Inferring procedure, diagnosis and necessity from the denial letter means patients don't need to understand their own paperwork to fight it.
Offering several appeal framings keeps the human in charge of the argument while the AI does the composition.
What can be applied
When a system's defence is paperwork fatigue, automate the paperwork: lowering the cost of the counter-move beats informing people of a right they'll never exercise.
Aftermath
The Fast Company profile (October 2024) documented Klomhaus's appeal underway after the eight-minute draft; no aggregate outcome numbers were reported. Karau kept the tool free, with a tagline that states the target plainly: 'Make your insurance company cry too.'
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