ClaimPilot
AI assistant that helps patients fight denied insurance claims and win appeals
Pain Score
Severe Pain
Feasibility
Moderate
Revenue
Exceptional
Timing
Good Window
The Problem
Insurance companies deny 17% of claims. Patients give up, paying out of pocket. Fighting appeals is complex, time-consuming, and feels impossible.
Pain Severity: Extreme - patients lose thousands of dollars and access to care. Denial rates increasing. 60% of denied claims would be approved if appealed.
The Solution
An AI tool that analyzes denial letters, identifies appeal grounds, generates appeal letters with proper medical coding, and guides patients through the process step-by-step.
Target Audience
Patients with denied insurance claims. 200M+ Americans with health insurance. 50M+ claims denied annually.
Market Analysis
Market Size
$6.4B patient advocacy market. Americans pay $88B annually in denied claims they could appeal.
Competition
Most focus on provider-side billing. Consumer-facing claim appeal tools are rare. Massive opportunity in patient empowerment.
MVP Execution Plan
Timeline: 12-16 weeks for MVP
Build denial letter upload and parsing
Create AI analysis engine for appeal grounds
Develop appeal letter generator with templates
Build step-by-step appeal workflow
Add deadline tracking and reminders
Implement success tracking and learnings
Recommended Tools
Revenue Model
Model Type
Freemium + success fee
Pricing
Free basic analysis, $29 for appeal letter generation, optional 10% success fee on recovered amount
Projected MRR
$100K MRR achievable helping 5,000 patients monthly
Why Now?
Healthcare costs at ATH. Denial rates increasing. AI can now understand medical/legal documents. Consumer healthcare tech having a moment.
Proof Signals
Reddit Threads
r/HealthInsurance - : "Claim denied for surgery I already had. Insurance wants $23K. I dont know what to do" (4.2K upvotes)
r/personalfinance - : "Medical bill after denial ruined me. Wish I knew I could appeal" (3.1K upvotes)
r/medicine - : "As a doctor, I see patients give up on valid claims constantly" (1.8K comments)
Community Signals
Search Data
"how to appeal insurance denial" 74K monthly, "insurance denial letter template" 22K monthly
Trends
Healthcare transparency laws passed. Patient advocacy growing. AI legal/medical tools raising millions.
Target Keywords
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