Engineer Turns Frustration with Healthcare Denials into Free AI Tool for Patients

Holden Karau, a dedicated open-source engineer based in California, has turned her frustration with the U.S. healthcare system into a revolutionary tool aimed at helping individuals navigate the often complex and daunting task of appealing health insurance denials. With a robust background in big data and experience working at nearly every major tech company—excluding Facebook—Karau found herself compelled to create Fight Health Insurance, a free AI-powered platform designed to streamline the appeals process. The catalyst for Karau's project was her personal experience with health insurance claim denials while searching for trans healthcare in California and recovering from a motorcycle accident. As she faced the challenges of the U.S. healthcare system, she realized the significant impact that denied claims can have, noting that they lead to "a lot of suffering in the world today." This realization ignited her determination to take action. "I'm not going to put up with this anymore. It's time to fight back," she declared, a sentiment that led her to name her creation Fight Health Insurance. Karau's journey didn't end with her own experiences. A later encounter with her dog's pet insurance further fueled her motivation to transform her proof of concept into a fully functional consumer product. "I was like, I've had enough. This needs to not just be like a curiosity," she explained, emphasizing her desire to make the tool accessible to the average person. Eliminating barriers to entry, she decided to offer the service free of charge. Users can easily navigate the platform by entering basic information, uploading a claim denial letter, and, if applicable, their insurance plan documents. Utilizing advanced machine learning algorithms, Fight Health Insurance identifies key details and employs a sophisticated language model to extract pertinent data from PubMed. Karau has ensured the privacy of users by anonymizing sensitive information, removing names and addresses from the documentation generated. Once an appeal is produced, users have the option to review and edit it before submitting it—either by mailing it themselves or for a nominal fee of $5, having the company fax it. This added service came in response to user feedback highlighting the inconvenience and cost of printing, showcasing Karau's commitment to user experience. "It's a little weird working on an AI project and then going on to eBay to buy fax modems," she remarked, reflecting on the sometimes unexpected nature of her work. In a healthcare landscape increasingly dominated by AI technologies, Karau believes Fight Health Insurance levels the playing field for patients. While she supports the use of AI in medical decision-making, she sees immense potential for AI tools in the administrative aspects of healthcare, such as insurance claims. Karau envisions a future where these tools can also assist healthcare providers in managing their interactions with insurance companies, alleviating the burden on doctors who often find themselves overwhelmed by insurance-related tasks. Since launching in August, Fight Health Insurance has garnered significant interest, with over 1,000 users already benefiting from the platform. Although the platform does not currently track success rates for appeals, Karau has received encouraging feedback, including success stories from users who have managed to overturn health insurance denials with the help of her tool. One user, after successfully appealing a denial for back surgery, expressed excitement about returning to motorcycle riding—a testament to the platform's potential impact on individual lives. Karau is mindful of the broader discussions surrounding the health insurance industry, particularly in light of recent high-profile incidents that have sparked public outrage. As consumers continue to voice their frustrations with the healthcare system, she has noted increased traffic to the Fight Health Insurance website, indicating that many are seeking solutions to their insurance woes. "I think consumers are hurting a lot in the health insurance space right now," she said, underscoring the urgent need for accessible resources in this area. Looking ahead, Karau plans to maintain the consumer version of the platform as a free service, while also developing a professional version for hospitals and medical vendors. "Doctors are just super frustrated with all the time they spend dealing with insurance companies," she noted, highlighting the shared challenges within the healthcare ecosystem. As Fight Health Insurance continues to evolve, Karau remains committed to empowering patients and improving the often frustrating landscape of health insurance appeals, one claim at a time.