AI is helping patients fight insurance company denials

Stephanie Nixdorf's insurance company declined to cover a drug to treat her arthritis. That changed after she sent an appeal letter crafted with help from AI.

Stephanie Nixdorf was at Disney World with her family in December 2021 when she got the call. A mysterious bump on her elbow was melanoma, her doctor said. Tests later showed it was Stage 4, with spots on her lung and two tumors in her brain.

Nixdorf, 51, a mother of four who lives with her husband, Jason, in Davidson, North Carolina, began treatments immediately, and by January 2024 her cancer was abating. The Premera Blue Cross health insurance offered by her husband’s employer had covered her cancer care, but in early 2024, when Stephanie’s doctors prescribed a drug to battle crippling arthritis induced by her immunotherapy treatments, the denials began.

“I used to run, play tennis, be active,” Nixdorf told NBC News. “Now I can’t even open a yogurt or grip a steering wheel in the morning.”

Jason and Stephanie Nixdorf.NBC NewsPremera Blue Cross, a not-for-profit licensee of the Blue Cross Blue Shield Association in Mountlake Terrace, Washington, is a leading health plan in the Pacific Northwest, serving 2.5 million people. For nine months in 2024, it denied repeated requests by Nixdorf’s doctors to cover infliximab, an inflammatory arthritis drug they’d prescribed.

With his wife in agony, Jason Nixdorf had a chance encounter with Zach Veigulis, a former chief data scientist at the Department of Veterans Affairs who was co-founding a company to help patients battle insurance company denials. That company, Claimable Inc., built an AI platform that allows patients to generate customized appeal letters containing comprehensive assessments of clinical research on a drug or treatment and other patients’ appeals history with it. The cost: around $40.