Agent that appeals denied emergency-care and ambulance claims for patients with coverage disputes
Autonomous agent that detects insurance denials for emergency room and ambulance transport, assembles clinical/regulatory evidence, files appeals with the insurer and state regulators, and negotiates payment plans—handling the entire fight until the claim is overturned or reduced.
The problem
Patients who call an ambulance or visit an ER are often hit with surprise denials ($5K–$50K+) claiming the care was 'not medically necessary' or 'out of network,' even when triage protocols dictated the transport. Most patients lack the clinical or appeals knowledge to fight back and end up paying in full or settling for cents on the dollar.
Who has it: Patients with a denied emergency-care or ambulance claim ($5K+) from a major insurer (Anthem, UnitedHealth, Aetna, Cigna, Humana) who lack the time, medical knowledge, or legal resources to appeal themselves.
Why now: Emergency ambulance and ER denial litigation has exploded post-COVID; state regulators (NY AG, Texas, Massachusetts) are cracking down on insurers for systematic denials of emergency transport. Patients now have strong regulatory tailwinds and case law to lean on, but no tool to execute the appeals autonomously.
Where this came from
2 public sources behind this idea.
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