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they’re replacing insurance companies

Founders, Inc. • 2025-07-27 • 3:46 minutes • YouTube

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Revolutionizing Healthcare Billing: How AI Voice Agents Are Fighting Insurance Claim Denials

Healthcare in America is notoriously complex and frustrating, particularly when it comes to insurance claims. Hospitals like UCSF bring in substantial revenue monthly—about $536 million from insurance claims alone. However, a staggering $1.4 billion in claims went uncompensated in 2023 because many insurance claims were denied. This denial forces tens of thousands of patients each month to shoulder medical bills themselves, exacerbating financial stress and healthcare inequality.

The Problem: A Broken Insurance Claims Process

UCSF typically files around 170,000 insurance claims monthly, yet approximately 20%—or 30,000—are denied almost immediately. The responsibility then falls on the hospital to fight these denials. While this might sound straightforward, the reality is far from it.

Before the 2000s, contesting a denied claim was often as simple as one phone call or submitting a single document to prove care was provided. Today, however, hospitals face an intentionally complicated process involving multiple phone calls (often five or more, each lasting 30 minutes), numerous documents (up to ten per appeal), and an average resolution time stretching over four months. Meanwhile, thousands of new patients are seen, and more claims pile up, creating an overwhelming backlog.

The Root Cause: Deliberate Complexity

Insurance companies have built extensive bureaucratic hurdles to slow down or prevent claims from being paid. They require hospitals to jump through as many as 50 unnecessary hoops, making the process inefficient and frustrating for hospital staff who are better suited to focus on patient care.

The Breakthrough: AI Voice Agents as Healthcare’s Secret Weapon

A groundbreaking solution has emerged from a team dedicated to automating these tedious insurance calls: AI voice agents. These agents mimic human conversations convincingly, complete with natural speech patterns, filler words, and even background noises to sound authentic. They can ask and answer the roughly 500 different types of questions insurance brokers might pose during a call, effectively navigating the labyrinth of bureaucracy.

In a trial with UCSF, AI voice agents handled 20,000 calls, refining their approach to maximize success. Interestingly, the team discovered that male voice agents had a 40% higher success rate in convincing insurance brokers compared to female voices. By the end of the trial, their best AI agent had a failure rate of just 2%.

Impact: Saving Time and Increasing Revenue

By deploying these AI voice agents, UCSF has been able to drastically reduce the time their staff spends on insurance calls, allowing them to focus on patient care. During the trial, the hospital hit record-high revenue levels thanks to more claims being processed successfully and faster.

Currently, these AI agents are active in 23 hospitals and medical billing companies, handling 5,000 calls daily. The technology not only boosts hospital revenue but also helps reduce the backlog of unpaid claims, ensuring patients don’t bear unnecessary financial burdens.

Why This Matters

The founders of this AI voice technology have deep experience in healthcare and understand the system’s pain points intimately. They are driven by a vision to make healthcare more accessible by eliminating one of the most fixable problems in the system: insurance claim denials.

By leveraging AI to automate and streamline the claims appeal process, hospitals can reclaim billions in lost revenue, reduce patient financial stress, and ultimately create a fairer, more efficient healthcare system.

Conclusion

Healthcare insurance claim denials have long been a thorn in the side of hospitals and patients alike. However, with innovative AI voice agents automating the grueling process of fighting denied claims, there is hope for meaningful change. This technology not only saves time and resources but also helps make healthcare more accessible and affordable for everyone.

As AI continues to evolve, solutions like these offer a glimpse into a future where healthcare bureaucracy doesn’t stand in the way of patient care and financial justice.

Interested in learning more about how AI is transforming healthcare? Stay tuned for updates on this exciting technology and its expanding impact.

📝 Transcript (121 entries):

These pins represent UCSF hospitals. Collectively, they bring in roughly $536 million in revenue every month, which is mostly made up of insurance claims. Patients walk in, receive care, and the hospital sends a bill to the insurance company. But in 2023, UCSF reported $1.4 billion in uncompensated claims, which means that the bill wasn't paid for. Normally, UCSF makes 170,000 claims every month. Roughly 20% of these claims get denied almost instantly. That's 30,000 people who now have to front the bill. Now, there are a lot of reasons why healthcare sucks in America. But fighting for claims is one of the worst problems we have. And unlike all the other reasons, we can actually fix this one. >> When a claim gets denied, it's actually on the hospital to go and fight the insurance company to get it covered. >> Before the 2000s, it used to be just one phone call or one document where a doctor proved that they provided care. But today, it seems like they've deliberately made it harder than it needs to be. Five phone calls, each taking half an hour. 10 documents for every appeal. All of this back and forth takes 4 months on average. By then, 160,000 new patients have come and gone. So, the backlog of uncovered claims just keeps piling up. >> All because they're forcing hospitals to go through 50 hoops that were never needed. But there's a team here, and they found a way to fight back. Yo, you guys busy? >> Yeah. We're building an army of voice agents for hospitals to automate their insurance phone calls. >> Hospitals take up way too much time to process insurance claims and it's obviously deliberate. >> All of the information that the insurance company asks for through this call can be easily accessed through a insurance portal or some software solution. >> It's just information that can be sent instantly if they wanted it, but instead they force you to make these phone calls. They have built entire armies to prevent you from getting through. So we are building our own. How would you say how would you? So over the past few years, AI voice agents have become more capable than ever. >> They sound just like us, can ask real questions that we would ask, but most importantly, they can direct conversations to get what we want. >> So one of the hospitals we work with does 5,000 calls per day to insurance companies to get these claims processed. And we provide thousands of AI voice agents to basically trick the insurance companies and go through all the hoops for them. So hospital staff can do things that actually matter and save their time. >> But why can't a hospital just hook up chatbt to their phone? In a typical insurance call, there are roughly 500 possible questions that can be asked. Their team learned this through a trial they ran with one of UCSF's hospitals where they processed an initial batch of 20,000 calls. They tested different voices, styles of conversation and questions. They filtered it down to four of the best people in their AI army and two important qualities. Realistic background noise like office sounds or street noise and realistic filler words like ums, buts, pauses. And they also discovered that male voices have a 40% higher success rate than female voices when talking to insurance brokers. >> Weird. >> By the end of their trial, the failure rate of one of their voice agents was only 2%. Which is why UCSF is trusting them to integrate into five of their hospitals next month after hitting a record high in revenue during their trial. >> Right now, they're deployed in 23 hospitals and medical billing companies, handling 5,000 calls every day, freeing up the staff's time for actual patient work. They're doing this for their friends, their family, ordinary people because they've seen countless stories just like this. >> All three of them have worked in the healthcare industry for years. So, used to make these calls himself, and David actually built one of the largest healthcare agents in Taiwan with 120,000 providers using it every day. >> They've experienced this problem firsthand, which is why they know how to fix it. What are you going to do for the world? >> I want to make healthcare more accessible. [Music] Hello.