Companies Use AI to Fight Insurance Denials
Despite many appeals being successful, people rarely challenge health insurance denials. New startups, such as Claimable and FightHealthInsurance.com, are working to change that message. According to a report by STAT’s Casey Ross, these companies utilize artificial intelligence and technology to analyze coverage requirements and draft appeal letters for doctors and patients. In recent years, nine companies have attracted approximately $36 million from investors, as noted by Rock Health.
Insurance companies have long relied on algorithms and predictive software for coverage decisions, often increasing denial rates. The emergence of companies aiming to combat these denials may signal a coming AI arms race, where both sides leverage imperfect, evolving technology in this ongoing struggle.
Eli Lilly Inks Zepbound Deal with Ro
This week, the telehealth company Ro announced a new deal with Eli Lilly, enabling customers to access vials of the weight loss drug Zepbound via its app. Previously, Lilly only offered these vials to patients through its online portal, LillyDirect. This action coincides with ongoing tensions between drugmakers and telehealth providers regarding the future availability of compounded versions of popular GLP-1 drugs.
Ro CEO Zachariah Reitano confirmed that Ro is committed to adhering to legal requirements, promising to offer compounded drugs only when placed on the FDA shortage list.
Telehealth Policy Wonks on Edge
The American Telemedicine Association is hosting its annual EDGE policy conference in Washington, D.C. Amid worries that Congress may not secure a long-term extension of pandemic-era telehealth policies before year-end, there’s bipartisan support for extending these rules, which expanded telehealth access for Medicare enrollees.
A coalition of advocacy groups has urged lawmakers to extend the telehealth rules for at least a year, emphasizing the necessity for stability to avoid disruptions in patient care during an uncertain policy environment.
Redesign Health’s New Fund and More
- Redesign Health raised $175 million for a new fund focused on artificial intelligence. This group has launched over 60 companies, with a notable exit being the hearing aid company Jabra Enhance.
- Cala Health secured $50 million to commercialize its wrist-worn neurostimulation device for essential tremor and Parkinson’s tremors.
- Talkspace partnered with the city of Seattle to offer mental health services to young people aged 13 to 24, continuing its mission following similar partnerships with Baltimore and New York.
AI Drug Design Showdowns Reveal Promise
Recent contests testing AI’s ability to design drugs showcase that while computational methods can yield promising results, perfecting this technology remains a challenge. In its latest CACHE challenge, competitors struggled to discover truly novel drug candidates, highlighting the persistence of established methods within the industry.
What We’re Reading
- ‘An autistic teen’s parents sue character.ai, claiming safety violations’ – CNN
- ‘FDA’s electric shock device ban draws criticism for delayed action’ – STAT
- ‘Insights on AI in biotechnology, from personal experiences’ – STAT
