S1 Ep59: AI and claim denials with Neal K. Shah, co-founder of Counterforce Health
- Author
- Medical Economics
- Published
- Mon 07 Apr 2025
- Episode Link
- https://audioboom.com/posts/8698914
Neal K. Shah, CEO of CareYaya Health Technologies and co-founder of Counterforce Health, joins the show to talk about claim denials and how AI can help fight them.
Be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.
Music Credits:
Cozy Evening Time Coffee by BJBeats - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to Claim Denials (00:00:23)
Overview of the podcast and introduction of the guests discussing claim denials and AI's role.
Neil Shah's Background (00:01:05)
Neil Shah shares his experience in healthcare and the impact of claim denials on patients.
Personal Experience with Claim Denials (00:01:36)
Neil recounts his wife's cancer battle and the frustrations of dealing with denied claims.
The Asymmetric Warfare of AI (00:03:09)
Discussion on how insurance companies leverage AI against patients and providers.
Provider Perspective on Claim Denials (00:04:12)
Insight into the financial and administrative burdens claim denials impose on healthcare providers.
Financial Impact on Practices (00:05:59)
Details on how denied claims lead to significant financial losses for medical practices.
Need for AI in Appeals (00:07:01)
Discussion on the potential of AI to streamline the appeals process and reduce costs.
Introduction to Counterforce Health (00:08:15)
Neil introduces Counterforce Health and its mission to democratize access to AI tools.
Maxwell: The Voice AI (00:10:06)
Introduction of Maxwell, an AI designed to assist with health insurance appeals.
Statistics on Claim Denials (00:11:43)
Maxwell shares shocking statistics about the financial impact of denied claims on practices.
Common Denial Reasons (00:12:30)
Discussion of the three most common denial reasons that practices can address to improve collections.
Case Study: James Wilson (00:13:55)
Maxwell walks through a specific case of a denied claim for a CPAP machine.
Call to Action for Providers (00:15:40)
Neil encourages providers to use the tools offered by Counterforce Health to combat claim denials.
Regulatory Changes Needed (00:16:27)
Neil discusses potential reforms to the claim denial process and the need for better regulation.
Patient Education and Advocacy (00:18:07)
Importance of educating patients about their rights regarding claim denials and appeals.
Final Thoughts on Healthcare Challenges (00:19:47)
Neil emphasizes the need for advocacy and systemic change in the healthcare system.
Conclusion and Thanks (00:20:29)
Closing remarks and gratitude expressed for the discussion and insights shared.
Be sure to check out Medical Economics Pulse, a quick-hitting news podcast that keeps busy physicians in the know.
Music Credits:
Cozy Evening Time Coffee by BJBeats - stock.adobe.com
Relaxing Lounge by Classy Call me Man - stock.adobe.com
COCKTAIL by Mythical Audio - stock.adobe.com
Editor's note: Episode timestamps and transcript produced using AI tools.
Introduction to Claim Denials (00:00:23)
Overview of the podcast and introduction of the guests discussing claim denials and AI's role.
Neil Shah's Background (00:01:05)
Neil Shah shares his experience in healthcare and the impact of claim denials on patients.
Personal Experience with Claim Denials (00:01:36)
Neil recounts his wife's cancer battle and the frustrations of dealing with denied claims.
The Asymmetric Warfare of AI (00:03:09)
Discussion on how insurance companies leverage AI against patients and providers.
Provider Perspective on Claim Denials (00:04:12)
Insight into the financial and administrative burdens claim denials impose on healthcare providers.
Financial Impact on Practices (00:05:59)
Details on how denied claims lead to significant financial losses for medical practices.
Need for AI in Appeals (00:07:01)
Discussion on the potential of AI to streamline the appeals process and reduce costs.
Introduction to Counterforce Health (00:08:15)
Neil introduces Counterforce Health and its mission to democratize access to AI tools.
Maxwell: The Voice AI (00:10:06)
Introduction of Maxwell, an AI designed to assist with health insurance appeals.
Statistics on Claim Denials (00:11:43)
Maxwell shares shocking statistics about the financial impact of denied claims on practices.
Common Denial Reasons (00:12:30)
Discussion of the three most common denial reasons that practices can address to improve collections.
Case Study: James Wilson (00:13:55)
Maxwell walks through a specific case of a denied claim for a CPAP machine.
Call to Action for Providers (00:15:40)
Neil encourages providers to use the tools offered by Counterforce Health to combat claim denials.
Regulatory Changes Needed (00:16:27)
Neil discusses potential reforms to the claim denial process and the need for better regulation.
Patient Education and Advocacy (00:18:07)
Importance of educating patients about their rights regarding claim denials and appeals.
Final Thoughts on Healthcare Challenges (00:19:47)
Neil emphasizes the need for advocacy and systemic change in the healthcare system.
Conclusion and Thanks (00:20:29)
Closing remarks and gratitude expressed for the discussion and insights shared.
