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they’re replacing insurance companies

Founders, Inc. • 2025-07-27 • 3:46 minutes • YouTube

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Revolutionizing Healthcare Billing: How AI Voice Agents Are Fighting Insurance Claim Denials

Healthcare in America is notoriously complex, and one of the biggest headaches for hospitals and patients alike is the battle over insurance claims. At UCSF hospitals alone, these challenges highlight a critical issue: despite generating roughly $536 million in revenue monthly through insurance claims, UCSF reported a staggering $1.4 billion in uncompensated claims in 2023. These unpaid bills represent care that was provided but never reimbursed, creating a massive financial strain on healthcare providers and patients.

The Problem: Denied Claims and Endless Red Tape

Each month, UCSF files about 170,000 insurance claims. However, approximately 20%—or 30,000—of these claims get denied almost immediately. When a claim is denied, the responsibility falls on the hospital to fight the insurance company to secure payment. This process, which once involved a simple phone call or a single document from a doctor, has now ballooned into a bureaucratic nightmare.

Today, hospitals face multiple phone calls, each lasting around 30 minutes, and must submit upwards of 10 documents for every appeal. On average, this back-and-forth takes about four months—during which time thousands of new patients require care, and claims continue to pile up unresolved. These excessive hurdles are not just inefficient; they appear to be deliberately designed to discourage hospitals from pursuing legitimate payments.

A New Hope: AI Voice Agents to the Rescue

Recognizing the systemic inefficiencies, a pioneering team has developed a cutting-edge solution: AI-powered voice agents that automate the tedious phone calls hospitals must make to insurance companies. These AI agents mimic human conversations with remarkable realism, complete with natural speech patterns, background noises, and even filler words like “um” and “but,” making interactions indistinguishable from those with real people.

Hospitals like UCSF have already begun deploying these AI agents. One hospital using this technology manages around 5,000 calls daily to insurance companies, delegating the time-consuming task of navigating claim denials to thousands of AI agents. This automation not only accelerates the claims process but also allows hospital staff to focus on patient care instead of administrative burdens.

The Science Behind the Success

The development team conducted extensive trials analyzing around 20,000 calls to optimize the AI’s performance. They discovered that the AI’s success depended on several factors, including voice type—male voices had a 40% higher success rate in persuading insurance brokers—and realistic conversational elements that helped the AI agents pass through insurance gatekeepers.

By the end of their trial, the AI voice agents achieved a failure rate as low as 2%, a remarkable feat that led UCSF to expand their use across five additional hospitals. Currently, these AI agents are active in 23 hospitals and medical billing companies, handling thousands of calls daily and significantly reducing the workload on human staff.

Why This Matters

The people behind this innovation aren’t just technologists—they come from healthcare backgrounds and understand the frustration of denied claims firsthand. Their mission is clear: to make healthcare more accessible by eliminating one of the most fixable barriers in the system.

By automating the claims appeal process, hospitals can recover billions in lost revenue, reduce financial strain on patients who might otherwise be stuck with unpaid bills, and ultimately improve the efficiency and fairness of healthcare billing.

Conclusion

While many problems plague the American healthcare system, the fight against insurance claim denials is one we have the tools to fix. AI voice agents represent a promising breakthrough that combines advanced technology with real-world healthcare experience to tackle this persistent problem head-on.

As more hospitals adopt these AI solutions, we can look forward to a future where healthcare providers spend less time battling red tape and more time delivering quality care—and where patients aren’t caught in the middle of an endless claims war.

If you’re interested in the intersection of AI and healthcare, or want to learn more about innovations improving medical billing, stay tuned for more updates on this transformative technology.

📝 Transcript (121 entries):

These pins represent UCSF hospitals. Collectively, they bring in roughly $536 million in revenue every month, which is mostly made up of insurance claims. Patients walk in, receive care, and the hospital sends a bill to the insurance company. But in 2023, UCSF reported $1.4 billion in uncompensated claims, which means that the bill wasn't paid for. Normally, UCSF makes 170,000 claims every month. Roughly 20% of these claims get denied almost instantly. That's 30,000 people who now have to front the bill. Now, there are a lot of reasons why healthcare sucks in America. But fighting for claims is one of the worst problems we have. And unlike all the other reasons, we can actually fix this one. >> When a claim gets denied, it's actually on the hospital to go and fight the insurance company to get it covered. >> Before the 2000s, it used to be just one phone call or one document where a doctor proved that they provided care. But today, it seems like they've deliberately made it harder than it needs to be. Five phone calls, each taking half an hour. 10 documents for every appeal. All of this back and forth takes 4 months on average. By then, 160,000 new patients have come and gone. So, the backlog of uncovered claims just keeps piling up. >> All because they're forcing hospitals to go through 50 hoops that were never needed. But there's a team here, and they found a way to fight back. Yo, you guys busy? >> Yeah. We're building an army of voice agents for hospitals to automate their insurance phone calls. >> Hospitals take up way too much time to process insurance claims and it's obviously deliberate. >> All of the information that the insurance company asks for through this call can be easily accessed through a insurance portal or some software solution. >> It's just information that can be sent instantly if they wanted it, but instead they force you to make these phone calls. They have built entire armies to prevent you from getting through. So we are building our own. How would you say how would you? So over the past few years, AI voice agents have become more capable than ever. >> They sound just like us, can ask real questions that we would ask, but most importantly, they can direct conversations to get what we want. >> So one of the hospitals we work with does 5,000 calls per day to insurance companies to get these claims processed. And we provide thousands of AI voice agents to basically trick the insurance companies and go through all the hoops for them. So hospital staff can do things that actually matter and save their time. >> But why can't a hospital just hook up chatbt to their phone? In a typical insurance call, there are roughly 500 possible questions that can be asked. Their team learned this through a trial they ran with one of UCSF's hospitals where they processed an initial batch of 20,000 calls. They tested different voices, styles of conversation and questions. They filtered it down to four of the best people in their AI army and two important qualities. Realistic background noise like office sounds or street noise and realistic filler words like ums, buts, pauses. And they also discovered that male voices have a 40% higher success rate than female voices when talking to insurance brokers. >> Weird. >> By the end of their trial, the failure rate of one of their voice agents was only 2%. Which is why UCSF is trusting them to integrate into five of their hospitals next month after hitting a record high in revenue during their trial. >> Right now, they're deployed in 23 hospitals and medical billing companies, handling 5,000 calls every day, freeing up the staff's time for actual patient work. They're doing this for their friends, their family, ordinary people because they've seen countless stories just like this. >> All three of them have worked in the healthcare industry for years. So, used to make these calls himself, and David actually built one of the largest healthcare agents in Taiwan with 120,000 providers using it every day. >> They've experienced this problem firsthand, which is why they know how to fix it. What are you going to do for the world? >> I want to make healthcare more accessible. [Music] Hello.