The Bot That Said “No”
Don't Let an Algorithm Deny Your Health—Fight Back!
You open your mail one day and see it: the dreaded Explanation of Benefits. You know the color of the paper, the size of the envelope, and the sinking feeling that settles in your gut before you even open it. You tear it open, and there it is, plain as day: DENIED.
Now, you could just throw it in the trash and say, "Well, that's that." That's what the insurance company wants you to do, right? They're banking on it. They know most people won't even try to fight back. But what if I told you there’s a new villain in this story, a quiet, unfeeling robot that’s making these decisions for them?
Turns out, AI isn't just for predicting your movie choices anymore. It’s moved into the health insurance space, and it’s not playing nice. It’s denying claims by the thousands, and with minimal human review. Lawsuits are being filed against giants like Cigna, UnitedHealth, and Humana, alleging that they've been using these AI tools to fast-track denials and cut off care for patients.
Cigna's "PXDX": This algorithm allegedly allowed doctors to batch-deny thousands of claims in mere seconds, with some doctors reviewing as many as 50 claims at a time. Kisting-Leung, et al. v. Cigna Corp., et al., Case No. 2:23-cv-01477-DAD-CSK (E.D. Cal. July 24, 2023).
UnitedHealth's "nH Predict": This tool allegedly overrode doctors' recommendations and prematurely cut off coverage for patients. Estate of Lokken v. UnitedHealth Group, Inc., et al., 23-cv-03514-JRT-DTS (D. Minn. November 14, 2023)
Think about it: an algorithm deciding how much physical therapy you "should" need after a knee surgery. Or what kind of genetic testing is "medically necessary" based on a generic prediction, not your doctor's specific expertise. It's an AI-driven, bottom-line-focused decision, and it has absolutely nothing to do with your personal health and well-being.
This Is a Story, Not a Spreadsheet
Here’s where it gets personal. This isn't just a legal issue. It’s a human one. It’s about people whose tumors went undiagnosed because a robot thought an MRI was unnecessary. It’s about seniors getting cut off from vital post-acute care because an algorithm decided they were done. It’s about the stress and anxiety that piles up with each denied claim, the sleepless nights and the panicked phone calls.
The human cost of these algorithmic decisions is immense. A recent report found that nearly one in five in-network claims were denied in 2023. And guess what? Less than 1% of denied claims are ever appealed. Why? Because the system is built to be confusing and intimidating. They make it hard to find out your appeal rights or who to even contact. It’s a feature, not a bug.
Your Secret Weapon: The Appeal
But here's the fun part. The one thing an algorithm can't do is write a powerful, persuasive appeal letter. That's your job. And here’s the secret: when you fight back, you have a surprisingly good chance of winning. Studies have shown that a significant number of appeals are successful, with some even showing success rates of 44% or higher at the first level.
Think of it like this: your appeal is your way of telling the robot, and the company that programmed it, that you're not going to be ignored. You’re not a variable in their cost-cutting equation. You're a person who deserves proper medical care, and you have a voice.
It's Your Turn to Act
This is not a call to action. This is a call to arms. Your health is on the line, and you have a right to fight for it.
At Appeal Templates, we've taken the mystery out of the process. We've created a FREE Appeal Guide and straightforward, easy-to-use legal letter templates designed to help you craft a strong, compelling appeal. You don't need to hire a lawyer or spend hours researching legal jargon. All you need is the fire in your belly and a little guidance.
An AI may have given you a denial, but knowing the process can help you navigate it. Your health is worth advocating for, so let's understand the landscape today.
You CAN Win Your Appeal
A denial letter is not the final decision. Insurance companies overturn claims every day when people submit a strong appeal.
Whether you use:
➡ The Free Appeal Guide
or
➡ The $29 Professional Appeal Template
—you can absolutely take back control and fight your denied claim with confidence.
Download Your Free Appeal Guide
Get the step-by-step instructions, evidence checklist, and sample wording you need.
Download Free Guide
Need a Full Appeal Letter Template? ($29)
Get a professionally drafted, fill-in-the-blank appeal letter tailored for medical claim denials.
Get the Full Template
