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These 10 startups are using AI to disrupt healthcare payments as public outrage toward insurers …
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These 10 startups are using AI to disrupt healthcare payments as public outrage toward insurers mounts
Rebecca Torrence
2024-12-11T17:39:45Z
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The killing of United Healthcare CEO Brian Thompson is bringing patients' bitterness toward health insurers to the forefront.
Stephen Maturen/Getty Images
Health insurers are coming under fire for increasingly denying patient claims for medical care.Investors are rushing to back startups using AI to automate the complex healthcare billing process.These 10 startups are helping patients, providers, and insurers improve health payments with AI.
In the wake of the fatal shooting of UnitedHealthcare's CEO last week, public hostility toward health insurers has reached a boiling point.After Brian Thompson was shot and killed in Manhattan on December 4, social media exploded in morbid celebration. Shell casings found at the scene of the crime reportedly showed the words "deny," "defend," and "depose," mirroring a phrase commonly used by insurance critics to describe tactics used by health plans to avoid paying claims. Suspect Luigi Mangione was arrested Monday with a note in his possession containing the line, "These parasites had it coming."
It's a reckoning for how healthcare in the US is paid for — or not paid for — as health insurers increasingly deny paying for patient care. UnitedHealthcare and other health insurers have come under fire in recent years for using algorithms to deny patient claims, particularly Medicare Advantage claims. Claim denial rates have been on the rise for more than a decade, and denied or delayed payments cost hospitals hundreds of billions of dollars a year.A growing crop of startups think AI can help.Investors are rushing to back startups using AI to help providers, patients, and health plans more accurately and efficiently pay for medical care.
These 10 startups are using AI to automate key parts of healthcare's complex billing process, from prior authorization to claims adjudication.
Alaffia Health
TJ Ademiluyi, CEO and cofounder of Alaffia Health.
Alaffia Health
Founded: 2020Total raised: $17.6 millionWhat it does: Alaffia Health works with health plans to automate time-consuming tasks in claims processing, such as reviewing large patient medical records and policy documents. The startup says its generative AI tools can help insurers supercharge their in-house clinical teams and reduce claims spending.Alaffia Health last raised a $10 million Series A round in April led by FirstMark Capital.
Anomaly
Mike Desjadon, CEO of Anomaly.
Mike Desjadon
Founded: 2020Total raised: $30 millionWhat it does: Anomaly uses machine learning to parse health insurers' policies and historical claims data to help clinicians predict and prevent claims denials. The startup was incubated by Redesign Health and has raised money from investors like RRE Ventures and Madrona.
Anterior
Anterior cofounders Tahseen Omar, COO, and Dr. Abdel Mahmoud, CEO.
Anterior
Founded: 2023Total raised: $23 millionWhat it does: Anterior provides tech to clinicians working inside health insurers to automate prior authorizations for covered medical care. The startup raised a $20 million Series A led by NEA in June. It's also backed by Sequoia Capital and Microsoft AI head Mustafa Suleyman.
Claimable
Claimable's chief AI officer Zach Veigulis, COO Alicia Graham, and CEO Warris Bokhari.
Claimable
Founded: 2023Total raised: UndisclosedWhat it does: Claimable launched in October to assist patients in creating appeal letters for denied medical claims. Its platform analyzes a range of data, including clinical research, insurer policies, and existing appeals data, to generate a personalized letter for $40.The startup last raised a seed round from Walkabout Ventures, Humanrace Capital, and other investors in March. It's also part of Nvidia's startup accelerator program Inception.
Cofactor AI
Adi Tantravahi, Cofactor AI cofounder and CEO.
Cofactor AI
Founded: 2023Total raised: $4 millionWhat it does: Cofactor AI's platform analyzes information, including medical records, insurer policies, and claims data, to help hospitals appeal claims denials. The startup announced a $4 million seed round led by Drive Capital in November.
Cohere Health
Cohere Health CEO Siva Namasivayam.
Cohere Health
Founded: 2019Total raised: $106 millionWhat it does: Cohere Health contracts with health plans like Humana and Geisinger to automate prior authorizations for medical care. The startup claims its tech can reduce the number of unnecessary prior authorization denials to help patients get the care they need faster. Cohere Health last raised a $50 million Series B extension in February led by Deerfield Management.
Humata Health
Humata Health founder and CEO Dr. Jeremy Friese.
Humata Health
Founded: 2023Total raised: $25 millionWhat it does: Humata Health works with hospitals to automate the collection of documents included in requests for prior authorizations sent to insurers and flag likely denials. The startup raised a $25 million Series A in June, led by LRV Health and the Blue Venture Fund.Dr. Jeremy Friese started Humata Health after serving as the president of health AI startup Olive, which shut down last year after selling its prior authorization business to Humata.
Goodbill
Goodbill cofounders Patrick Haig, CEO, and Ian Sefferman, CTO.
Goodbill
Founded: 2021Total raised: $5.3 millionWhat it does: Goodbill works with patients and employers to reduce medical costs by cross-referencing medical records with incoming hospital bills to identify potential errors and overcharges. The startup last raised a $2 million funding round in March from Founders' Co-op, Maveron, and Liquid 2 Ventures.
Guardian AI
Founded: 2024Total raised: UndisclosedWhat it does: Guardian AI provides hospitals and physician groups with tools to analyze insurance reimbursement patterns and automate the handling of unpaid medical claims and denials. The startup was part of YCombinator's summer 2024 cohort; its founders previously worked on Palantir's AI revenue cycle management programs for hospitals.
Thoughtful AI
Dan Parsons, Thoughtful AI cofounder and chief product officer; Alex Zekoff, cofounder and CEO; and Chris Singleton, VP of automation.
Thoughtful AI
Founded: 2020Total raised: $40 millionWhat it does: The startup's AI agents help healthcare clinics process medical claims, check patient insurance coverage, and record payments. Thoughtful AI last raised a $20 million Series A in July, led by Drive Capital.