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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 complicated and expensive, with insurance claim denials being one of the most frustrating and costly issues for hospitals and patients alike. A striking example comes from UCSF hospitals, which collectively generate about $536 million in revenue monthly, primarily through insurance claims. However, in 2023 alone, UCSF reported a staggering $1.4 billion in uncompensated claims—bills that were never paid.

The Problem: Insurance Claim Denials and Their Impact

Every month, UCSF submits around 170,000 insurance claims. Shockingly, approximately 20% of these claims—about 30,000—are denied almost immediately. This shifts the financial burden directly onto patients, many of whom are left to cover expensive medical bills out-of-pocket.

Why are so many claims denied? The healthcare billing process has become intentionally complex. Previously, resolving a denied claim might have required just one phone call or a single document verifying care. Today, hospitals must navigate an exhausting labyrinth of bureaucracy: multiple lengthy phone calls, submitting numerous documents, and enduring months of back-and-forth appeals. On average, it takes four months to resolve a denied claim, during which tens of thousands of new claims accumulate, creating an ever-growing backlog.

The Hidden Battle: Hospitals Fighting Insurance Companies

The frustrating reality is that hospitals bear the responsibility of fighting denied claims. The insurance companies have built extensive barriers—multiple “hoops” to jump through—that significantly delay or even prevent payment. This costly and time-consuming process drains hospital resources and detracts from patient care.

The Innovative Solution: AI-Powered Voice Agents

Enter a groundbreaking technological innovation: AI voice agents designed to automate the tedious insurance claim phone calls. A dedicated team has developed an “army” of AI voice agents that mimic human conversations with remarkable accuracy. These agents can ask relevant questions, respond naturally, and navigate the complex dialogues required to get claims approved.

One UCSF hospital alone makes 5,000 such insurance calls daily. By deploying thousands of AI voice agents, hospitals can automate these conversations, drastically reducing the time spent on administrative tasks and freeing staff to focus on patient care.

Why Not Just Use Regular Chatbots?

Insurance calls are not simple Q&A sessions—they involve roughly 500 possible questions, requiring nuanced and adaptive conversations. Through extensive trials involving 20,000 calls, the AI team refined their agents by testing different voices, conversational styles, and background noises to ensure realism. Surprisingly, they found that male voices had a 40% higher success rate with insurance brokers.

The result? A failure rate as low as 2% in handling calls, proving the efficiency and effectiveness of these AI agents.

Real-World Impact and Future Prospects

Following a successful trial that helped UCSF hit record revenue, the AI voice agents are now being integrated into five UCSF hospitals and deployed across 23 hospitals and medical billing companies nationwide. They handle thousands of calls daily, significantly reducing the administrative burden on healthcare staff.

The creators of this technology have deep roots in healthcare, having experienced the frustrations of claim denials firsthand. Their mission is clear: to make healthcare more accessible by removing unnecessary barriers and streamlining the insurance claim process.

Conclusion

The complexity and inefficiency of insurance claims are a major contributor to the high costs and frustrations in American healthcare. However, as this innovative use of AI voice agents demonstrates, some problems can be solved with smart technology. By automating insurance calls, hospitals can recover more payments, reduce patient financial burdens, and most importantly, dedicate more time and resources to delivering quality care.

This breakthrough is a promising step toward a more efficient, fair, and accessible healthcare system—one phone call at a time.

📝 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.