Stephanie Nixdorf’s battle against cancer took a complicated turn—not due to her diagnosis, but because of a health insurance denial. As she sought relief from the arthritis caused by her immunotherapy, her insurer repeatedly rejected her prescribed treatment. Yet, thanks to an powered AI health insurance appeal, her family forced a reversal. This case sheds light on a growing trend where technology is empowering patients to challenge and overturn coverage denials in the U.S. healthcare system.
AI Steps In Where Insurance Fails
In December 2021, Stephanie Nixdorf was diagnosed with Stage 4 melanoma while on a family trip to Disney World. The cancer had already spread to her lungs and brain. She began treatment right away. By early 2024, her condition was improving, and the Premera Blue Cross plan through her husband’s employer had covered her care.
But when her doctors prescribed infliximab to treat severe arthritis—an inflammatory condition triggered by her immunotherapy—coverage hit a wall. Over the next nine months, her medical team submitted repeated requests for the drug. Each was denied.
Stephanie described her physical struggles as debilitating. “Now I can’t even open a yogurt or grip a steering wheel in the morning,” she told NBC News. Her mobility and quality of life had plummeted.
An Encounter That Changed Everything
Jason Nixdorf, Stephanie’s husband, met Zach Veigulis by chance during this challenging period. Veigulis, a former chief data scientist at the Department of Veterans Affairs, was co-founding Claimable Inc.—a startup using AI to help patients fight insurance denials.
When Jason reached out, Claimable had not yet launched its platform, but the company’s CEO, Dr. Warris Bokhari, agreed to help. They used Claimable’s AI system to generate a 23-page appeal letter. It included detailed clinical research, citations from insurance policy language, and a history of prior approvals for infliximab.
The letter was sent to Premera’s executives and regulators, including the governor and attorney general of North Carolina. Within two days, Premera reversed its decision and approved the drug.
Systemic Denial Patterns
Stephanie’s case is far from unique. In 2023, marketplace health plans under the Affordable Care Act denied 19% of in-network claims, according to a January 2025 study by KFF. Fewer than 1% of patients appealed those denials. When appeals were filed, insurers upheld 56% of them.
The process is often opaque and exhausting. The Nixdorfs attempted multiple calls to Premera’s toll-free number, left unanswered messages, and faxed required documentation. They also sent letters of medical necessity and requested peer reviews—without success.
Premera issued three denials: first claiming the drug was “not medically necessary,” then labeling it “investigational,” and finally stating it lacked FDA approval. However, infliximab is a standard treatment for inflammatory arthritis and is listed in the National Comprehensive Cancer Network Drugs and Biologics Compendium.
Questions of Fair Review and Oversight
In reviewing the documents Premera provided, the Nixdorfs found troubling details. The doctor assigned to evaluate Stephanie’s case lacked relevant expertise in cancer or arthritis. More concerning, Premera’s independent review was handled by AllMed Healthcare Management—led by a former Premera executive, Jeff Card.
The family questioned whether the process was truly independent. Premera declined to address this concern directly but stated that AllMed is accredited and subject to quarterly audits and reviews.
Premera also acknowledged procedural failures. “There was no intent to deny care,” said spokeswoman Courtney Wallace. She attributed the delays to a processing error and policy misapplication. Wallace also admitted there was a breakdown in communication with the Nixdorfs and emphasized that Premera aims to improve its process for providers.
Permanent Damage from Delays
Stephanie finally received access to the prescribed medication in September 2024—nine months after her doctors first requested it. Her husband said the delay resulted in irreversible joint damage.
“If we had gotten the OK in January, it could have been knocked out and done then,” Jason Nixdorf said. Her condition now requires ongoing treatment and management, which might have been avoided with earlier intervention.
Medical experts say untreated inflammatory arthritis can lead to lasting disability. Yet, the appeals process often stalls long enough to allow permanent damage.
AI Becomes a Lifeline for Patients
Companies like Claimable are now giving patients tools to fight back. Their platform scrapes medical databases, prior approvals, and regulatory policy to draft appeals that can compete with insurers’ internal reviews. The cost of Claimable’s service is around $40—a fraction of what prolonged treatment delays might cost.
Claimable’s co-founder Veigulis reported that their model has overturned nearly 1,000 denials. He said the system focuses on high-impact treatments in areas like rheumatology and migraine care.
“People who meet the eligibility criteria and pay their premiums still can’t access care,” Veigulis said. “It is wild.”
A Wider Pattern of Denials
Tabitha Lee, a former paramedic now working in rheumatology at Wilmington Health in North Carolina, said she sees similar patterns daily. She handles insurance authorizations for about 100 patients a day.
“Insurances were denying medications that patients had been stable on for years,” Lee said. She explained that insurers often push patients toward alternative drugs that may be on their formularies but aren’t always appropriate.
Lee noted that changing medications can cause adverse effects and destabilize patients who were previously well-managed.
Another AI Tool Makes a Difference
Lee started using AI-generated appeals from Counterforce Health in February 2024. This nonprofit, founded by Neal K. Shah, builds custom appeal letters based on the patient’s policy and a record of similar appeal outcomes. Shah also leads CareYaya Health Technologies, which supports elder care through student caregivers.
Counterforce sends the appeals not only to insurers but also to state regulators. “Denials should be appealed,” Shah said, “but most people don’t because they’re intimidated by the process.”
With this AI support, Lee reported faster turnaround. “I’ve gotten back approvals on the same day and the day after,” she said. The AI saves time and helps her focus on other tasks like patient assistance and prior authorizations.
