How Health Insurance Companies Turn Claim Denials Into Shareholder Returns

Massive, publicly traded financial services institutions, healthcare insurance companies. You pay a monthly premium, they decide which care you get. Publicly traded companies have one goal in mind, and that's to maximize shareholder value. It's their legal obligation. 110 to 130 million Americans a year face some type of denial. They might have said not medically necessary, they might have said experimental or investigational. Okay. Feels like a David versus Goliath kind of situation here. You have the law on your side though, Which is something they don't have. What's up, everyone? I'm your host, Vivian Tu, a.k.a. your rich BFF and your favorite Wall Street girly. And today, we are back on Net Worth and Chill to talk about something that has genuinely made me so angry the more I've learned about it. Health insurance. Specifically, what happens when you actually try to use it. because you pay your premiums every single month. But the moment you need your insurance to show up for you, they find every reason to say no. And most of us just accept it. We get the denial letter, we feel defeated, we pay the bill, and we move on. But my guest today is here to tell you that is exactly what they are counting on. Zach Vigalas is the co-founder and chief AI officer at Claimable, an AI-powered tool that helps everyday patients fight back against insurance denials and he knows this system inside and out. We're getting into the villain origin story of health insurance, why claims get denied, and how to actually appeal one and when. This episode is genuinely one of those that you are going to want to send to every single person in your life. Okay, Zach, thank you so much for being here. Yeah, thanks for having me. We are going to have such a great conversation, but before we can talk about health insurance today, I want you to kind of give me the villain origin story of health insurance. When did it start? What was it initially intended to do? What did it turn into? Sure. Yeah, definitely. I mean, I don't think anybody had intended for it to start and end up like it looks like today. So back in the Great Depression, so almost 100 years ago, you know, hospitals were struggling to get paid and consumers were struggling to afford health care or really anything at all. So what a system down in Texas Baylor started doing was offering Dallas area teachers the ability to pay 50 cents a month for access to hospital services, which was a win-win. So it was a cheap access to care for teachers, and the hospital system had predictable revenue. Now, what it's turned into since then is really these massive publicly traded financial services institutions that call themselves healthcare insurance companies. And so now what happens is you pay a monthly premium to one of these companies and then they decide which care you get, what care you get. Now, that's problematic because publicly traded companies have one goal in mind, and that's to maximize shareholder value. It's their legal obligation, not just they want to, they have to. Legal fiduciary responsibility, legal obligation to maximize shareholder value. So what does that mean? It means maximizing profits. So the incentives have completely shifted from, hey, accessible healthcare for the average consumer, predictable revenue for healthcare systems into there's a third party now that is dictating your care. And so what happens is there's about 5 billion medical claims a year in the United States, about 20% or around a billion of those are denied and less than a million are appealed. So in summary, the system is working exactly as it's designed. It's just really not patient friendly. What was the moment that like that actually changed? Because it sounded like they had a great system in, you know, Baylor had that great system, were little healthcare insurers popping up throughout the country, like one in Florida, one in California, like all of these things. And then they tried to nationalize and it just didn't work. That's exactly right. So in the 1970s, there started, I mean, basically what happens after the Great Depression, the tax code changed to where they were incentivizing employers to essentially sponsor health insurance for people. I always wondered why our insurance was tied to our employer. Exactly. So in the 1970s, the government got involved and they said, hey, we're going to pass an act called ERISA, right? And so what ERISA does is that that regulates both the retirement aspect of your benefits as well as your essential health insurance benefits. And what we're going to do is we're going to try to protect patients or employees, if you will. And we're also going to try to protect employers. And so ERISA was passed in 1974 as this kind of continued to spiral. And then really since then, there was clearly a business model to adopt. And that's ultimately what's happened. These insurance companies have popped up and gotten massive and that's where we're at today. That is honestly so disappointing. But I want to go back to those numbers you mentioned. Five billion health insurance claims every year. A billion with a B gets denied. And one million appeals. That feels like a crazy number, by the way. First off, for a fifth of all claims to be denied seems quite high. And then on top of that, for only a tiny, tiny fraction, very literally one one thousandth of the claims that are actually denied to be appealed, those odds don't seem good. That's correct. That's the way it's designed, right? Yeah. They don't want you to fight back. So essentially denials are a lever that payers can pull or insurance companies can pull to protect their profits. Yeah. So if that's ultimately their goal, if you think about their incentive, as you mentioned, legal responsibility to maximize shareholder value, this is a cheap lever. They depend on patients not fighting back. It is very cheap to issue a denial, especially when 99.999% of patients don't appeal. It is actually pretty expensive to handle an appeal, believe it or not. Yeah. The going back to the act that was passed in the 70s. So when ERISA was introduced and passed in 1974, what it did was it allowed patients the right to appeal. And it also said the insurance company was ahead of its time. The insurance company has to appoint a board certified specialty match physician to review the case. Like an actual doctor. An actual doctor has to review your care. Now, most patients don't know that. And if they did know that, they really wouldn't know how to do it. So hopefully we can spend some time today kind of digging a little deeper into how to appeal, why you should. Yeah, we definitely are going to. Absolutely. And the chances of winning are pretty high. So I guess my first question is just like why do claims get denied in the first place? We pay for health insurance. Shouldn't health insurance pay for us? Yeah, you would think so. So, again, it's a lever to protect profits essentially. But what do they say the reason it's getting denied? Great question. They use a term – they use terms like not medically necessary or medical necessity. That sounds like an official clinical term. But actually that term has no clinical value whatsoever. That's not something that you learn in med school, right? Like that is a scary thing that is presented by insurance companies to try to get out of paying care. And one thing that I will say is there's the profit protection piece, right, which is clearly it's cheaper to – we protect profits if we don't have to pay claims. But there's also this idea of outdated policies as well. So when you go to a doctor, you know, your doctor, you expect them to stay up to date on the newest and greatest care that's out there. Right. You want to get the best outcome. Insurance companies aren't always staying up to date. Yeah. And for a reason. Right. So their policies, they might be looking at this through could be decades old in some cases. So, you know, not medically necessary could be, hey, we don't want to pay the claim. It could also be our policy says that you don't meet criteria for this thing that you're trying to access, such as a service like a MRI or a medication. But ultimately, there's been new practice guidelines that have been adopted since then that say this is actually the best thing for you. And the clinical autonomy that your physician has, being the expert, knows what's best for you. And to confirm, do those insurance companies still have that board-certified doctor reviewing appeals? Yes. Oh, so that's still a thing. That is still a thing. So when a patient appeals, this cannot be adjudicated with AI, right? So you're not – And a lot of those claim denials are definitely AI. Absolutely. There's statistics that have recently came out that show over 70 percent of large insurance companies are using AI and the rest of them are looking at it. So almost all of them. So, yes, they can – there is nothing stopping them from looking at your initial claim through the lens of an AI. But when you appeal, that has to be a specialty match physician. So, again, the economics breakdown, if they have to appoint somebody internally to review these things manually, all of a sudden that's no longer a lever that they can pull to protect their profits. Can I put on my like conspiracy theory tinfoil hat really quick? Absolutely. I feel like if we got more people to appeal, these insurance companies would stop denying claims as often because they don't want to pay the doctor to then review the appeal. So then we wouldn't need the doctor to review the appeal because there would be fewer claim denials, right? Exactly. We would change the economics of how health care is delivered in this country with that solution right there. I feel like you just like light bulbs inside of my brain. But, you know, obviously we talked a little bit about appealing these claim denials. And your perspective is we should absolutely be appealing every single time. So let's do a little role play. I want you to walk me through the steps that we should take to fight back. And essentially tell me, walk me through every step and let me know how quickly I need to do this while we're doing this together. Okay. So you come to me. I'm Dr. Vivian. You come to Dr. Vivian and I say, hey, Zach, we need to do an x-ray on your knee. Mm-hmm. And I submit this You go and you get the x And your knee is all different kinds of messed up You submit to your insurance It naturally goes through the system and they hit you with a hello, Zach, please check your portal. You go online, by the way, you barely remember the login, you get onto the portal and it's like, hey, sorry, your x-ray, your insurance claim for us to cover that was denied. Now what? Great question. So likely that was presented in what they call an explanation of benefits, right? Or an EOB for short. So what that is, basically like an itemized list of services that you receive. So in that situation, you know, the EOB would reflect, you got paid for an office visit. You diagnosed me with, you know, knee pain and potential obstruction of sorts. You ordered the MRI, or sorry, the x-ray. We can order an MRI if it actually makes more sense. Whatever. And ultimately, I received the care, right? You administered the x-ray, and now I'm getting the bill. So what I would want to hear from the insurance company is, first, give me the denial letter for that exact service. And I want to understand exactly why you denied that. What that's likely going to say is that it's not medically necessary. How do you request that? Is it online or do you get it mailed to your house? Yes, either one. So they have a legal obligation to provide a denial letter with every denied claim for that specific service. So first I want to see that. Then I want to see what they denied me for. They might have said not medically necessary. They might have said experimental or investigational. Okay. Scary words. Yeah. Okay. So first I want to understand that. Now I want to go back to the findings, right? You said we found out that your knee was pretty messed up. Yeah. So clearly we did that for a good reason. Yeah. So what I'm going to do is I'm going to look at my denial letter. I'm going to take all those facts that we've collected here. And I'm first going to, after I identify the denial reason, I'm going to identify my appeal window, which should be 180 days. You should have 180 days to appeal. So now what I'm going to do is start drafting my appeal letter. and because I already had the service, it's not an urgent thing, right? That they stop everything they're doing and review this in three days. It's like me checking your heart for cardiac problems. Exactly. Or being left without cancer care or something like that. But ultimately the healthcare system wants to get paid, right? They did the service or I'm going to have to pay the bill. So I'm going to draft my appeal letter. I'm going to talk about what happened, right? Why I needed the MRI. I'm going to talk about or the x-ray. Sorry. Why I needed the x-ray. and I'm going to talk about what the findings were on the x-ray. That's going to give me all of the evidence that I need to show that this was actually medically necessary. And I'm going to find – if I can, I'm going to find scientific studies that help me back that up. If I can. If I can't, that's great. That's okay. And any applicable laws that are protective. So depending on the type of plan that you have, ERISA might be the governing body. It might be your state insurance. A lot of 44 out of 50 states have laws that are protected for patients to appeal. So I'm going to try to figure out what applies to me. And then I'm going to send the appeal letter to my insurance company. And likely what's going to happen is they're going to overturn the case. And I'm going to, you know, I'm not going to have to pay the bill. And the health care system is going to be made whole and be paid by the insurance company. because the board certified doctor on the back end looking at that saying hey your knee was all messed up in that x-ray or mri or whatever is probably going to agree with your doctor exactly because the doctors didn't go to school to make a ton of money people don't do that right for 10 years of suffering exactly they do it because they want to help people and they also take an oath first do no harm right right and that's that's like applicable across the board so if you're a physician who's in practice, even at the insurance company, you've still taken that oath. Yeah. And insurance companies have entire legal and medical teams on their side. And I'm going to be honest, while you were walking me through the appeal process, my eyes glazed just a little bit. That sounds quite complicated. I want to give you a second to talk to us a little bit about what Claimable AI does, how it's helping people, what leverage that they actually get to be able to pushback? How would I use that? It's a great question. So they do have massive teams on their side, right? It feels like a David versus Goliath kind of situation here. You have the law on your side though, which is something they don't have. So again, going back to the seventies, patients have had unique appeal rights. That was then expanded again in the early two thousands with the Affordable Care Act. And then 44 out of 50 states have some type of patient appeal process in addition to the federal law. So no matter what plan you have, commercial, government, whether that be Medicare, Medicaid, you have a right to appeal as a floor. So everybody. Everybody has a right to appeal no matter what. Now, what does claimable do, right? So it does sound like a lot to do this. So the best analogy I have for claimable is like turbo tax for appeals. Oh, okay. So, you know, every year you have to file your taxes. You don't have to be a CPA. You click all the little buttons. Click all the little buttons in a way that you understand, right? And then you leave with your taxes filed. Same thing with claimable. So you come to claimable, you bring your denial letter. We do the heavy lifting. We read your denial letter. We identify the denial reason. We identify the best argument that we can construct to fight that denial. And then we ask you questions that are relevant to your clinical history. So let's say a medication, for example. Let's talk about migraine. Migraine affects about 40 million Americans. Oh, I'm sorry to hear that. Yeah. 40 million Americans suffer from migraines. And for a long time, very debilitating without really any type of intervention at all. Now, there's been a new class of drugs that have came to market in the last 10 years or so that are showing a lot of promise and even curative for some patients. The American Headache Society says that new class of drugs, of CGRP antagonists, should be first line of defense. You shouldn't have to fail Excedrin and then you fail Emetrex. You should get that first. So anyways, 40 million Americans, a big swath of the country. those specialty medications are denied around 40 of the time according to medical evidence yeah so you have a coin flip of getting it if your doctor says you need it come to claimable we ask you questions specifically around your migraine journey what have how do your symptoms present you have 10 15 migraine days a month we capture all of that from you you're not able to take care of your kids you're estranged from family you have marital issues now because you can't participate and family. So we try to, based on your condition, we ask you very specific questions. That's all you have to do. You answer those questions. And then what we do is we go find the laws that are protective. We find the science that backs this up. We find anything else that can be helpful and protective for you to receive care. And then we construct an appeal letter for you. And then ultimately you leave claimable 15 to 30 minutes or so with a full appeal letter that's as detailed as I just laid out that goes off to your insurance company and has about an 80% chance of winning. 80 is good. 80 is good. 80 is a B, like a really good class, like B. You got a B in the class. A B. That's, and you know, it sounds kind of crazy to say, but you said only a million people appeal, a billion denials, that's 800,000 people that could be getting all of their stuff paid for. Absolutely. So, I mean, there's obviously not 5 billion people in the United States, right? But like that breaks down to somewhere between 110 to 130 million Americans a year face some type of denial. That is diabolical one. Diabolical. But two, I really do love that you guys have made it really easy and it seems like anybody can use this. Anybody can use it. I know this is something that people worry about a lot. You're providing such an excellent service. What does it cost? How much is it going to run me? Great question. So it's $39.95 plus shipping. We actually do fax and mail these. It's kind of antiquated. Believe it or not. The appeal letters. You have to mail them. The appeal letters. We have to mail and fax. I genuinely, if you were like, Vivian, your life depends on it. I don't think I could find a fax machine right now. No, you couldn't. I mean, or you have to drive to the post office or UPS. I mean, can you imagine sitting in line? No, it's crazy. So we do fax and mail these. So there's about $10 worth of shipping. The other thing is we work with pharmaceutical companies who sponsor our service. So for many of the drugs now, they're sponsored. So it's no cost to the patient at all. Oh, so for many people who are trying to appeal their insurance companies to cover certain pharmaceutical drugs, these pharma companies will actually pay claimable. so these patients can get the drug for free. That is so smart. Yep. And actually really, really cost-effective even if you're paying for it yourself. $39.99? 95? Yep. Plus $10, that's $50. If you've got a $500 medical expense, $50 seems decently reasonable, right? A lot of these medications cost upwards of thousands of dollars a month. Yeah. So definitely. Something else I want to talk about is medical billing errors. I saw a stat, another stat that really pissed me off. Apparently, medical bills, 80% of them have errors in them. So on the flip side of that 80, only 20% are correct. That is a failing grade in any possible classes. How do patients know whether or not their denial from their insurance company is actually rooted in, you know, something? or maybe the person at the desk just fat fingered the CPT code wrong. What should patients be looking at on their bills? It's a great question. Actually, I think 30% was the A in my organic chemistry class. Fair, but there was a curve on that. That was very, very hard class. No, it's a great question. So again, going back to the explanation of benefits or EOBs, make sure to access those. So if you're getting a, what would likely happen in this scenario is you're getting a bill from the healthcare system that says you owe, you know, $2,000 for the services that were rendered. So download your EOB from your payer portal. They should also send you this in the mail. I know most people don't check the mail these days. I'm one of those people. So the payer portal will have it and then run through it with a fine tooth comb, right? So what it will do is it will list out all of the services that you receive from the office visit to your diagnosis to you know the medications you were prescribed to any types of anything that happened in that office visit will be reflective there. And if you find something that wasn't done or that you didn't receive, that's a dead giveaway. So make sure to call the hospital billing office, call your provider and say, this is something simply that I did not receive and please resubmit that. Now, if you see – like there's another thing that happens that's kind of outside of the denial realm but still very important I think to mention is this idea of downcoding. So downcoding is – What is that? It's basically where the provider or the healthcare system and the payer don't agree on which code to use. So CPT codes are used for reimbursement, right? I spent 40 minutes with you. going through your physical, that gets me X amount of dollars in reimbursement. And so what the insurance company says is, well, we're going to reimburse you for 20 minutes at a time, not 40. Boo! Hiss! Yeah, exactly. So what will happen sometimes, right, this doesn't always happen, is the insurance company will downcode what the health insurance system has submitted, and then you get left with the balance. So make sure to review that. That's actually against the law. You should not be balance billed. The other thing is if there's any terms on there around not medically necessary or experimental investigational, that is an invitation to appeal. So if you see any of those words or step therapy or formulary exception, anything like that, that's an invitation to appeal and then in which case you should go find that denial letter. But for any type of just simple billing errors like that we're discussing today because it is rampant, most of those can be handled with the billing office at the healthcare system. I'm just curious. Are there certain types of claims or specific procedures, diagnoses, situations that get disproportionately denied at like a higher rate and why? Yeah, definitely. So about half of all claim denials are for medications and then the other half are for services. So like MRIs, CT scans, transplants, like surgical cases. And so those that are higher cost are going to be targeted more. Higher cost is targeted more? Higher cost is targeted more. So if the medication costs more expensive, the medication costs more. or if the – it's a surgical case. It's very expensive. It's going to be highly scrutinized and often denied. So going back to the payer policy, I have a couple of examples of this. So we helped a woman, but her name is Stephanie. Stephanie came to claimable with stage four melanoma, which is a very sad diagnosis and not that long ago that was pretty grim. However, the prognosis with emergence of new types of cancer therapy is actually pretty good now. Now, one of the side effects of these new cancer drugs is that they have weird things happen. And so what happened to Stephanie is she developed this inflammatory arthritis to the point where she couldn't even take the cap off the milk carton without being in excruciating pain. So she had four different physicians that said she needs a medication called infleximab to treat this basically symptom. Exactly. She acquired arthritis. And she was nine months into her journey when she showed up at Claimable. They had appealed three separate times and were told no three different times. So we were able to get her overturned in two days and her insurance company actually issued a public apology that said we had misapplied our policies three separate times. So again, having policies that are outdated can also attribute to this high denial rate. Now, that case was also on NBC Nightly News. Yikes. So maybe the insurance apology came because of that. Another example which is – Most certainly it came because of that. I'll let you be the judge. The other thing which I think is really important to note here is on the topic of denials are not a victimless crime. So we've helped eight cases of transplant denials, liver transplants specifically. The good news is we've gotten all of them overturned. In all the cases, the payer policy or the insurance company policy was being applied that had science in it from 2003. Science came a long way since 2003. Practice guidelines change very frequently. We're continuing to advance science at record speeds. So all of these, according to NCCN guidelines and any type of new practice guidelines in oncology, these patients were great candidates for transplant. And the thing about transplant as well, you can't walk into the hospital system, raise your hand and say, I want a new liver. You have to go through a very rigorous workup that includes physicians from all different backgrounds that have to all unanimously say, you're a candidate. So they had been through that arduous workup and then at one point or another in the journey, they had been told by insurance no, which is horrible, right? That's a life-saving, in this case, life-saving treatment. We got all eight of these overturned, which is really great. Not all eight, however, were still eligible by the time the insurance company made the decision, which we'll never know if it was due to the care delay or if something else, if it would have happened anyways. But ultimately, all of these cases were overturned, yet not everybody ended up receiving the care that they were ultimately denied for, which is very sad. Heartbreaking. Very heartbreaking. I want to pivot this a little bit because I think we've seen a lot on social media, just surgeons, doctors, people who are actually here to help the world. They truly are doing the Lord's work. Yes. They're on the phone and they are in tears, sobbing, cussing out insurance companies. What role do you think a patient's doctor should be playing in this whole process, maybe in an appeals process? And how do you get a ultra busy or reluctant physician to kind of go to bat for you? It's a great question. And I appreciate you acknowledging how busy and overworked these guys are, right? They're like, hey, 20 minutes, next patient, 20 minutes, next patient. So adding – I mean ultimately what it comes down to is there's – again, backing this claim up with evidence. There's evidence to show that about 18 percent of providers appeal consistently. So that's one in five. Four out of five don't. So what happens is providers are overworked. They're underpaid. They're burnt out. They get into medicine because they want to practice medicine. They don't want to deal with insurance. Nobody wants to do the paperwork. Yeah. Exactly. The other thing that I think – and you highlighted on this is the virality on TikTok of different physicians taking to social media to explain their journey with payers and trying to fight back and all the things. At the end of the day, the doctor is a subcontractor of the insurance company if you think of it that way. Explain that. So insurance companies have networks for care, right? In-network, out-of-network. In-network, out-of-network. So if you're an in-network physician, you've negotiated a rate with that insurance company and ultimately the people that have, let's say, UnitedHealthcare now have access to your clinic and you. Well, if you live in a geographic area that has 80% to 90% of people in that geographic area that have UnitedHealthcare and you piss them off, they can drop you from their network And then all of a sudden your practice goes belly up, which actually happened to Dr. Elizabeth Potter, if that's a case that you've followed at all. No, tell me about it. So Dr. Potter, she's in the Southwest and she's a plastic surgeon. And she – this went very viral. Dr. Potter is actually an advisor for Claimable now. We love what she's done and what she stands for. But ultimately she was – so she was dealing with a patient that was – had a breast cancer diagnosis. She was intra-surgery. So literally the patient was on the table receiving a mastectomy and the insurance company called and said, this is denied. And so what she did was she left surgery. She took the call, argued with this – with the insurance company, ultimately finished the surgery and then took to social media to tell her story. She's been dropped from coverage now and her practice is bankrupt or close to it. And this is – she's very publicly talked about her now financial struggles on pushing back with insurance. And it's very sad. So not only do they not have the time to push back, they also run the risk of biting the hand effectively that feeds them. And so it's really a rock and a hard place. Now, to bring optimism to this – Yeah, that was really dark. We got really dark there for a second. OK. All of the legal protections that I'm talking about today are afforded to patients, not to providers. So you have a right as a patient to appeal. Everybody does. Your provider doesn't actually have any legal right to appeal on your behalf. You have the right. So if everybody could fight back and leverage their legal right, that would change – truly change the economic viability of denying claims like you had stated a little bit ago. So there is an optimist silver lining in here that even if your provider cannot engage, it's great if they do. You still have the right to appeal. And then another stat that we have, which is claimable specific, is when a patient appeals and they do not include a letter of medical necessity or any type of attestation from their provider, they win just as much as if they do. Okay. So there's no statistically significant difference on including your HCP in the process or healthcare provider as there is with doing it on your own. So I feel like you just punched me in the gut. Like that makes me so sad for Dr. Potter because like she was trying to do the right thing. Very much so. They all are. Man. If someone can't afford the bill while that appeal is still pending or what have you, because I think a part of this is like, yes, you want to net out in the end, but like we are also living on a flat timeline. What options do they have so that they not like sent to collections What options do they have to you know speed up the process frankly Great question So if you receiving a bill from you know going back to your example a little bit ago from your hospital system that says, hey, you owe $800 in 30 days, pay it now, or you're going to collections and you find some type of error, you can ask for what's called a billing hold. So you can say, hey, look, I found some errors and discrepancies. I'm working through this with my insurance company. Please put a billing hold on. The other thing that is not well known and frankly underutilized is that a lot of these hospital systems have grant programs, patient assistance programs. Charity care if they're getting government money. There's a lot of money that just goes to waste every year that isn't leveraged. So definitely reach out to your healthcare system, your billing department and ask for what type of resources are available. And then the other thing is for things like medications, right? So medications, the migraine medications we were just talking about, those manufacturers likely have some type of patient assistance program that you can enroll in, right? So if you've been denied care, approach the manufacturer of the medication that you've been prescribed, tell them that you're having problems with insurance, you're appealing, you're working through that, and they will likely give you a free product while you work through that. And those are called patient assistance programs and more specifically bridge programs that bridge you from the point of denial into commercial coverage? It's so funny that you mentioned this. I have pretty bad eczema and asthma, so I'm on DuPixent. It is a decently pricey injectable medication. And when I saw that when I first got prescribed it, the first month's supply was going to be $3,000. I was like, I feel very comfortable in my finances. This still feels like a luxury. Like I feel like I just can't have clear skin. And the manufacturer of DuPixent, they actually have a like benefits card that covers the first $10,000 of your prescription for the year. And then once that's out, you're on your own. But typically what happens for, in my case, I'm on a high deductible health plan and by the time I've spent $10,000 of their money, I've now reached my deductible and my insurance covers my DuPixin. Fun fact, you can appeal for DuPixin on Claimable for free. That is a sponsored medication. We love DuPixin. Like I really do love DuPixin. It changed my life. That's so interesting. You mentioned federal versus state. Yes. Talk to me about certain states. Are some states better at protecting their citizens? Are others worse? Which ones should we be keeping an ear out for? So 44 out of 50 states have some type of patient appeal rights. And some states are better than others and some states don't have anything at all. So looking at you, the South, but many states in the South don't have protections. But New York and California typically have the best, as you can imagine. They both have not only patient appeal rights that are expanded. They have things like continuity of care laws. They have protections around use of AI, things like that, and many states do now. So not only do you have patient appeal protections, there's also specific laws that protect patients that are suffering from cancer, patients with potentially rare conditions where coverage is limited because in order to get you know scientific evidence to back up a rare disease it's very hard so patients are left without any coverage at all so there's rare disease protections there's step therapy protections that say you know the gut the the insurance company can't restrict you from what you should try and fail beyond what your doctor has said you need to do. So yes, there's, I will say New York and California are typically the most comprehensive, but there's a lot of states out there with very comprehensive rights and condition specific ones that you should look into as well. And if someone is, you know, denied at every single level, what's kind of like the nuclear option? Things like your state's insurance commission or like, what do we do? Great question. Yeah. So on the self-funded side, that means that your large insurer is actually paying the claim. The logo on your insurance card is just who they've employed to administer the claim. So if your employer has like over 500 people in it, likely it's called a self-funded plan. That's ERISA. You can – there's ERISA litigation that you can bring forward and then also the Department of Labor is the watchdog for ERISA plans. So you can escalate these to your local regional Department of Labor office who will then apply pressure to your employer and their third-party administrator to make sure that those plans are being administered correctly. On the fully insured side, which makes up about 40 percent of all commercial plans, that is ERISA, Affordable Care Act, and your state law. So the federal regulators are still applicable but also Department of Insurance, your insurance commissioner in your state as you mentioned and really anybody else that you want, senators, governors, anybody that can be influential, certainly include them. And on the Medicare-Medicaid side, similar. So those are – on the Medicare side, those have watchdogs that are in the Department of Labor, in the federal government, and then also on Medicaid, it's more state-driven. But there's always an escalation path for each one of these plans. And then the most nuclear – so if you follow the process of appealing and you're not successful, which doesn't happen to many people by the way. Most people leave there with a favorable outcome. But social media is very powerful too. Right. And I don't think I mean, legally speaking, those are the ways to escalate this through the channels that exist. But applying pressure, social pressure through social media is extremely valuable. Yeah. The last thing these companies want to do is be on the front page of the news because they had denied somebody lifesaving treatment. Yeah. Because you can live and die by the court of public opinion. Absolutely. Yeah. One thousand percent. Amazing. So I want to circle back. I think you've shared so much wisdom today and honestly, really grateful that you and your team are building out claimable AI. There are some people who are reluctant to input their personal information into AI. Anything you can say to kind of assuage some of those fears? Because at this point, I'm kind of feeling like we've got to use AI to fight the insurance company's AI. But like, is there something that you can say to make us feel better. It's a valid concern. I completely understand why people would have that type of concern. There's a lot of scary stuff that's out there these days. Giving chat GPT access to all of your medical records, let's say, which is a thing. We don't do that here. We don't do that here. What I will say is claimable is HIPAA compliant and SOC 2 type 2 compliant. So that's the highest level of security that we can obtain, which is hospital grade, enterprise grade security. So this is my commitment to you is I will never sell your data. I will never give it to insurance companies. We do not use your data to train new models. We use it in a very compliant way that only helps you get access to your care and nothing more, nothing less. So with us, it's very secure. It's encrypted in transit. It's encrypted at rest. We take security very seriously. Prior to starting Claimable, I was in the VA for 15 years. and the VA is locked down like Fort Knox. And they take security very seriously, both on the protecting, you know, the lives of their veterans that we serve, but also their healthcare. And so we apply the same principles within Claimable to make sure that that data never leaves Claimable and is never sold and can never hurt you in that way. Yeah. And, you know, you make a good point of like hospital grade encryption. Realistically, the hospital you go to is probably also using AI to some extent now, right? Absolutely. Like these doctors are not charting on their own anymore. Definitely. They need the help. Yeah, they're using scribes. They're using systems to do notes, those types of things. Absolutely. And we're using the same type of protections that they are to protect your data inside of the hospital walls. Exactly. Yeah. So, Zach, I only have one final question for you and then we'll learn more. But what do you hope to see in the future of healthcare? It's a big one. It's a big one. It's a big one. Simply put, I hope that the experience in healthcare goes back to a relationship between you and your provider, that a third party isn't coming in and telling you what you can and can't have. And I think that's best for patients. And I also think that is best for clinicians. And I think clinicians get into these – get into healthcare for the right reasons. And many of them burn out because they don't have clinical autonomy. It's not that they're overworked. It's that they can't do what they think they need to to serve patients best. And what it really comes down to is having a third party sort of looking over your shoulder, checking everything that you do. So in order to get there, this is a big pie in the sky dream. I believe that we can change the economic model of health care by removing denials as a lever that they can pull cheaply. And I think the way to do that is through appeals at scale, which will help us move more towards a model where it's a relationship between you and your physician. I think that's a really good way to end this. Zach, thank you so much for joining me. Please tell everyone where we can find you and Claimable AI. GetClaimable.com is our website. So you're welcome to check it out. And you can find me on LinkedIn, Zach at GetClaimable.com. If you want to reach out via email, it would be great. And if you're finding something that you might not find on our website, please reach out. We do a lot of philanthropic work on the site as well. So we have a finite number of things that we support on our website, but we have a nonprofit arm and we have some other R&D things that we do to support patients that are dealing with big, hairy things like transplant. So please reach out if you need anything at all. Thank you so much for joining me. Yeah, thanks for having me. Thanks for tuning into this week's episode of Net Worth and Chill, part of the Vox Media Podcast Network. If you like the episode, make sure to leave a rating and review and subscribe so you never miss an episode. Got a burning financial question that you want covered in a future episode? Write to us via podcast at yourrichbff.com. Follow Net Worth and Chill Pod on Instagram to stay up to date on all podcast related news. And you can follow me at yourrichbff for even more financial know-how. See you next week. Bye.