Healthcare Finance & Economics
The Truth Behind Health Insurance Denials with Warris Bokhari
April 2, 2026
When a health insurance company denies life-saving medical care, it isn’t just a bureaucratic hurdle—it’s a hidden public health crisis that costs lives. In this episode of Value Health Voices, Dr. Amar Rewari and Dr. Anthony Paravati sit down with Time 100 Health List honoree Warris Bokhari, founder of Claimable, to expose the shocking reality behind the nearly one billion medical denials issued every year. Listeners will learn exactly how to fight back against predatory insurance tactics and successfully overturn wrongful claim rejections, especially in high-stakes fields like oncology.
Drawing from his insider experience at Anthem and Apple Health, Warris pulls back the curtain on how insurers use proprietary AI algorithms and fabricated terms like "medically unnecessary" to boost profits at the expense of patient care. The conversation explores the heavy toll of prior authorization and utilization management, the disturbing conflict between fiduciary responsibility and clinical ethics, and how Claimable operates as the "TurboTax for health insurance appeals" to wage asymmetric warfare against corporate giants. Warris also reveals a brilliant, legally-backed framework for using ERISA laws and employer liability to force insurers into approving delayed treatments, but you'll have to listen to find out the single most important step every patient must take within 48 hours of receiving a denial letter.
Don't let a devastating insurance denial dictate your health journey. Hit play to arm yourself with these essential medical advocacy tools. Be sure to subscribe to Value Health Voices, leave us a review, and check the show notes for a direct link to Claimable and other critical resources mentioned in this episode.
Episode Resources:
Marshall Allen’s Official Website and "Never Pay the First Bill"
STAT News: Investigation into UnitedHealth’s "nH Predict" Algorithm
The Reality of Medical Denials
Warris Bokhari:
You study it and you peel back the layers and you start dissecting the terms like medically unnecessary. That sounds like a legal word, but it's not. It's a made-up insurance term designed to discourage patients from challenging something that arrives on letterhead paper.
For some patients, it means the difference between curation and hospice. I've seen that be the case. I've seen physicians give up. I've seen physicians become afraid to challenge the denials because they're worried the rest of their claims will be scrutinized by payment integrity.
Introducing Warris Bokhari and Claimable
Dr. Amar Rewari:
Welcome back to this episode of Value Health Voices. We have a guest with us who I'm very excited to introduce. He was an honoree on the Time 100 health list this year for 2026, and I met him at the dinner for his honor.
He's a physician by training but has worked in GE, Apple Health, Anthem, and Amazon. He's founded a company called Claimable that helps prevent or fight back against insurance denials for patients. Warris Bokhari, tell us a little bit about what got you into starting this company and a little bit more about yourself.
The Scale of the National Denial Crisis
Warris Bokhari:
Thank you for having me, Amar. And Anthony, thank you. It was a long journey to get here. Anybody who's in clinical practice will know colleagues who left medicine during residency. The reason they leave is often because they want to have more impact in a shorter amount of time.
There is a certain satisfaction you get from treating the individual patient, but at some point, the call of the wild becomes something you follow. That pulled me from what I thought was a promising career in clinical medicine into a career in industry. I wanted to move the needle in terms of diagnostics, therapeutics, payment mechanisms at Anthem, and digital health at Apple.
Eventually, it occurred to me that there were still many families in this country struggling to get basic access to healthcare. I grew up in England, so for me, this was completely alien. PBMs exist here, for example. No one in England has ever heard of a PBM, and I pray for them that they never do.
I remember standing in a CVS parking lot being educated by someone on the phone that my prescription was something totally different. That was the first thing that clued me in that things here were very different. I then went on an excursion of reading the great books by Elisabeth Rosenthal and Marshall Allen, who have written about this problem.
It wasn't until I worked at Anthem that I saw the scale. I went there because it’s a good place to go if you have the opportunity to inflect the course of care for a third of insured Americans. I realized that no one really understands grievances and appeals, even there. When you look at the numbers, there's a big dislocation between denials and appeals.
When we started this company in 2023, there were something like 850 million denials. Now that number is closer to a billion denials and roughly a million appeals every year. Listeners are probably thinking there aren't a billion Americans who are insured, so how does this net out?
It works something like this. There are roughly 300 million Americans and roughly a billion denials. If you think of each person seeing their doctor three times a year and each visit being associated with four claims, it boils down to roughly 90 million Americans a year dealing with a denial.
It is staggering. Only about a million appeals get filed, so what happens to the rest? I grew up with two disabled parents, so we never had to deal with care getting denied. If it had, it would have impacted them. They had little ability to fight back and wouldn't have known how to navigate such a Byzantine system.
Appealing is hard, so we automated it. We built TurboTax for appeals. We've been moving through biologics starting with things that are morbidity-bearing and moving into drugs that are mortality-bearing. In the next quarter, we intend to be very active in oncology.
The Burden of Utilization Management in Oncology
Dr. Anthony Paravati:
That's what Amar Rewari and I face every day. For those new to the Value Health Voices podcast, I am Dr. Anthony Paravati, the Executive Medical Director of a multi-site cancer program. Amar Rewari is the chief of radiation oncology at a health system on the East Coast.
All things utilization management and the denials our patients face are extremely heavy. They exact a psychological toll on patients and an administrative toll on us as physicians. We are myopically focused on cancer, and it feels like it has to be the worst in cancer because medicines and therapies are so expensive. Patients getting their care delayed due to these problems is particularly egregious in our world.
Warris Bokhari:
We wanted to start in oncology, but the reason we didn't is because even with good intent, you can still do great harm until you prove you've got the chops to be in that world. A lot of the oncology cases that found us initially came via LinkedIn and people finding me on the internet.
I saw people showing up to clinics with binders. We got more and more confidence that oncology was inflectable but also entirely wrong on the facts. There is a moral imperative to have a high-fidelity, high-quality appeal solution for patients because too much care is getting delayed.
A Hidden Public Health Crisis
Dr. Anthony Paravati:
You mentioned the extremely high numbers of denials and how perhaps just 1% of those denied claims end up appealed. You called it a hidden public health crisis. Could you explain what you mean by framing the issue that way?
Warris Bokhari:
A lot happens in the privacy of people's homes. These private tragedies play out within four walls. A mom or dad can't go to work because a kid is sick, meaning other kids deal with their parents focusing all their energy on that one child.
There is loss of income or a small business losing a valued employee. You then see the sequelae of delayed care. You move from a household to a neighborhood and the ripple effects are felt as they move outward from one nuclear family. I get phone calls from families all the time who are struggling to cope with the economics of denied care.
Case Study: Reversing a Life-Threatening Denial
Dr. Amar Rewari:
I wanted to go back to oncology because an oncology case put you on the map on NBC News with Stephanie Nixdorf. She had stage four melanoma. Tell us a little bit about that case, the appeal letter, and how AI got involved.
Warris Bokhari:
Stephanie and Jason are amazing humans. Even though we won, I always say that the ambiguity in the lives of patients with chronic diseases goes on. I'm never in a position where I want to declare a victory without acknowledging that ambiguity.
Stephanie had stage four metastatic melanoma and had been on a checkpoint inhibitor. A recognized side effect is checkpoint inhibitor-induced arthritis. It is recognized in the National Comprehensive Cancer Network Guidelines as a complication. They needed Infliximab to manage her symptoms, but Premera Blue Cross said no.
They sat on it for a while and didn't want to rattle the cage with the employer. After nine months, Jason came to us to see if we could appeal. We appealed it and beat it in one or two days.
When you think about cancer and a Kaplan-Meier survival curve, if you delay someone nine months, you are materially impacting survival. She was delayed in her next phase of chemo by this severe arthritis. If it was a denial that could have been reversed in two days, it should never have happened.
The Mechanics of Insurance Industry Tactics
Dr. Anthony Paravati:
What your company did and the letter you put together was truly awesome. Warris Bokhari, Amar Rewari and I have wrapped ourselves into this world for various reasons. Did you have to study the utilization management landscape deeply before launching the company?
Warris Bokhari:
It is Byzantine and Kafkaesque. I understand the idea of preventing unnecessary care, but the people who do it today have no corresponding duty of care to the patients.
When I went to Anthem, it was a good faith effort to change care models. We ran a randomized control trial in asthma and made a dent in a Medicaid population. But when you look at the harms done, they are not abstract. I am fascinated by the human experience inside illness.
When you start thinking about this as just a spreadsheet decision based on an ROC curve to set approvals and denials, it isn't victimless. You study it and peel back the layers and dissect terms like medically unnecessary. It is a made-up term designed to discourage patients.
I've seen physicians give up or become afraid to challenge denials because they're worried their other claims will be scrutinized by payment integrity. I learned that term during my time in insurance. It basically means you are delaying, slow-paying, or under-paying the provider.
Fiduciary Responsibility vs. Shareholder Value
Dr. Anthony Paravati:
And you end up with the money in treasuries to earn no-risk return.
Warris Bokhari:
It's a great deal for the CFOs at the insurance companies, but it's a terrible deal for the patients. Plan designs have moved to shift the majority of the cost from the plan to the patient. More people are enrolled in high-deductible health plans.
I worked on a radiotherapy denial for a 34-year-old man. I met my wife when I was 34. I cannot imagine what his family is going through. On a high-deductible health plan, you might have a catastrophic amount of money to pay out.
Dr. Anthony Paravati:
There is absolutely no alignment between clinical responsibility and these companies. Their primary responsibility is fiduciary to shareholders. Or their client is a self-insured employer, and their responsibility is to minimize spend. This is where CEOs, CFOs, and heads of HR are exposed legally to essentially hurting their own employees under federal law.
Dr. Amar Rewari:
I used to work for an investment bank. When we evaluated financials for insurers, we looked at their benefits management programs and how effective they were. To maximize shareholder value is the goal. They couch it in the idea that 25% of utilization is fraudulent or abusive, but in reality, it's about margins and profit.
Vertical Integration and the PBM Model
Warris Bokhari:
They like to pretend it's a higher power protecting the world from fraud, waste, and abuse. In the time since running this business, I've seen maybe one appeal that didn't meet the criteria. In oncology and transplant, I've seen none of that.
I've seen patients go from curation to a death sentence by being delayed. I heard from a widow whose husband died after his transplant was delayed by Cigna. It was a stage four lung cancer case. He got matched to lungs and was due to be transplanted, but his kidneys failed while waiting. Those ten days would have made all the difference.
I saw another patient, Nathan Kirkland, a young guy with cholangiocarcinoma. He was due for a living donor liver transplant. We saw the story going viral on Super Bowl Sunday and reached out to help. We worked all night with Mark Cuban and got it overturned.
He went for evaluation, but the disease was too far advanced. They chose not to proceed. Transplant is very regulated and goes through an ethics board and UNOS. The idea that an insurer can overrule a qualified transplant board is something I will never understand.
My offer to the insurance companies is simple: stop prior authorizing in cancer and transplant. You would actually have a leg to stand on regarding other pricing issues, whereas right now you have none. My co-founder was meant to be on stage with Michelle Gourdine at CVS and Ratna Kilaru from Elevance.
CVS pulled out. Elevance just said the same talking points I heard years ago: bidirectional data exchange and transparency. They suggested the providers go first and said they were deploying chatbots. These are not good answers for a multi-billion dollar company.
Dr. Anthony Paravati:
These omni-channel healthcare companies have the insurer business and third-party benefits managers. They make unrestricted profits on one side while claiming constraints on the other. The entire definition of what is medically necessary is controlled by a small group of companies using proprietary guidelines, like Milliman and Interqual, which are both owned by insurers.
Warris Bokhari:
Exactly. For the TransMet study for colorectal cancer, it was a well-regarded multi-center study showing an 85% chance of survival at five years. BCBS Texas's medical policy pours water on it, saying it’s European or unideally cohorted.
Anthem and Blue Cross Blue Shield Illinois use that same language. They have chosen the least charitable interpretation. I end up quoting NCCN back to the insurer to point out their facts are nonsense. I knew a medical policy guy who described his time writing policy as being paid for with RSU therapy—restricted stock unit therapy.
Dr. Amar Rewari:
With Medicare Advantage plans and the medical loss ratio, while 85% of money is supposed to go to clinical services, that includes quality improvement. Utilization management falls under quality improvement. It allows them to decrease the percentage actually going to the patient. It’s wild that they create restricted guidelines used by non-specialists to deny care.
Warris Bokhari:
They play a game of cups with the regulators. Through PBMs, they found unregulated revenue with no cap. Then all the insurance companies started owning PBMs—like CVS owning Aetna. You get this push for verticalization.
Optum owns clinics and 10% of the country's doctors are employed by UnitedHealth. When you have an incentive to allow unregulated revenue, prices rise because 85% of a larger number is better for them. People need to be clear on that.
When Elizabeth Warren and Josh Hawley call to break up the insurers, they are exactly right. I think this will eventually happen by natural causes because I'm not convinced politicians have the stones to do it. The regulatory capture on the Senate and House side is complete.
Dr. Anthony Paravati:
You can't escape these omni-channel companies. If there was only one gas station in town, the price would be whatever they said it was.
Dr. Amar Rewari:
There are only five companies governing almost all insurers and insurees in the country. It is vertically integrated with very few players.
AI Arms Race: Bots vs. Bots in Healthcare
Dr. Anthony Paravati:
Dr. Eric Bricker did a great video on how these companies operate regarding regulated versus non-regulated revenue. Looking at the AI arms race, companies like eviCore and United have programs like The Dial or nH Predict. These were shown in investigations by Stat News to be wrong almost all the time in terms of restricting acute care.
Warris Bokhari:
When I started this, I mused on LinkedIn about arming LLMs to help patients argue back. Insurance people started calling me telling me not to do it. That was all the confirmation I needed. I tried to raise money, and some investors said they couldn't because they needed to exit part of their portfolio to Optum.
It’s already bots versus bots. AI agents on the hospital side fight against solutions like Change Healthcare sold to insurers. Denial rates are going up 25% a year. But none of these have been deployed for patients.
Patients have unique rights. The Affordable Care Act requires a qualified medical professional to review appeals. ERISA has protections around full and fair review. Forty-one states have protections for medical review that only apply to patients. We make sure the attorney general or senators like Josh Hawley or Elizabeth Warren get mail from us.
If an insurer sees an appeal going to two attorneys general across state lines, that’s a bad day for them. My job is to make their days as bad as possible for wrongfully denying patients.
Dr. Amar Rewari:
Is that what differentiates your letters? You insert the regulatory compliance issues and copy the appropriate individuals where a regular doctor's letter might fail.
Warris Bokhari:
They are more likely to take us seriously. They look at your contractual relationship with them as a filter. A practice in Missouri got removed from Anthem's network for speaking truths on TikTok. Elisabeth Potter was pushed out of the United network and faced bankruptcy because she stood up for a patient.
Providers genuinely think twice about pushing hard. When the patient does it, it’s different. We construct unique arguments based on the best evidence and the specific laws for that plan.
We also copy the employer. The employer is the payer and often doesn't know what is happening. I was talking to Cliff Hudis at ASCO, and he sees his role as providing healthcare to the employees at ASCO. In giant companies, these issues never rise to the top.
I had a patient at a top ten company whose kid had an upper thoracic spinal cord injury. United denied the hospital admission as medically unnecessary. We wrote a compelling letter and put it on the desk of the C-suite of that giant company. United became very scared. Those big companies see benefits as a way to retain valued employees, and they will go to bat for them if they know the truth.
ERISA and Employer Liability
Dr. Anthony Paravati:
Some companies don't understand their own legal exposure under ERISA if they don't act as fiduciaries. Kraft Heinz was sued for several hundred million dollars for not acting as a fiduciary. If you go the self-insured route, you own it all.
Warris Bokhari:
When you move into a self-funded plan, you're offering health benefits, not insurance. State laws are preempted by ERISA. People are drawn to self-funding because they don't want to pay giant premiums to Cigna or Anthem for a decreasing value proposition.
Mid-market companies get drawn into cost containment. They say they'll give you great oncology care, but then exclude MD Anderson, Sloan Kettering, or the Mayo Clinic. Congratulations employer, we’ve contained your cost, but these sites of care are excluded.
There's no prohibition on step therapy. You might have to try and fail four cheaper medications or multiple biosimilars before you're allowed a medication that actually works. We found that including the employer in the letter makes a 20% difference in the data.
Dr. Anthony Paravati:
You have an 80% success rate with your appeals. Is that still accurate?
Warris Bokhari:
It varies. In oncology, the success rate is currently 100%. For transplant and migraine, it’s 100%. For GLP-1s, it’s substantially lower because obesity isn't always recognized as a health condition, allowing for plan exclusions.
An Accessible Business Model
Dr. Amar Rewari:
You charge $40 to $50 per appeal, which is very accessible. The insurers are spending millions on AI systems. How are you managing to compete at that price?
Warris Bokhari:
Asymmetric warfare. We are AI to the core and keep it lean. Our team is in the Midwest, in Ohio. We didn't hire Silicon Valley people who won't get out of bed for less than 600 grand a year. Everyone here has had an issue with healthcare denials.
People ask why we don't charge a success fee. I grew up in a family that could barely rub two nickels together. If someone needs a million-dollar surgery and you tell them they can have it but they now owe you $200,000, they can't pay that.
We are moving into working with health centers. If you are a specialist oncology center, give me a call. We also work with pharma on bridge programs and patient assistance. There are enough ways for us to make money without taking it from the patient.
The Need for Economic Change
Dr. Anthony Paravati:
Hospitals would love to contract with you to help their bottom line and their patients. There have been investigations into these actors, but will those investigations or rules make a dent?
Warris Bokhari:
There are no teeth. It’s all performative. They get their hands slapped and go back to doing the same or worse. The answer is going to be economic. We need to create real options for employers and give patients tools to combat denials.
We need to fundamentally degrade the economics of denying via AI. We need to ask why we are defending a payment model that doesn't work for investors, providers, or patients. The system is fragmented and balkanized.
The reckoning will come from investors. Someone will go activist inside United or Cigna and try to divest the insurance division. When a company owns 3,000 disparate entities, it’s too much to manage. I saw this at GE; it was the poster child of the conglomerate, and it doesn't end well.
Dr. Anthony Paravati:
We don't have many conglomerates around anymore.
Warris Bokhari:
You're not nimble. If in 2026 Anthem is talking about the same thing they were in 2019, they haven't gotten a lot done. There's no incentive for modernization. When you're built on 1960s mainframes in COBOL, the answer to spending billions to modernize is always going to be "not." Economic pressure must force them to change.
Dr. Amar Rewari:
What are your thoughts on "gold carding," where you eliminate the need for prior auth for certain providers?
Warris Bokhari:
It's like the golden ticket in Charlie and the Chocolate Factory. How do you get one? We had one practice get gold carded because we sent so many appeals that the insurer just wanted us to leave them alone.
Dr. Anthony Paravati:
In states like West Virginia and Michigan, it's become required, but I haven't heard of much gold carding in the cancer space.
Warris Bokhari:
These delays are material. I think about what it means for a patient to lose a month or three months. I've seen too many people ring the bell and then not make it. Anything we can do to move that needle is work worth doing.
I'm exhausted by seeing patients pleading for their lives on LinkedIn. To the insurers: please stop prior auth in cancer. You would do a lot of good and likely save money. You wouldn't need all the medical directors or the people required for review.
In the late 90s, United stopped prior auths for a while. At some point, there was an idea that it wasn't saving any money. I would argue it isn't saving any money at all, unless you own a prior auth company and call it revenue.
Actionable Steps for Patients
Dr. Anthony Paravati:
This has been a great conversation. If a patient is listening and got a denial today, what is the single most important thing they can do in the next 48 hours?
Warris Bokhari:
Get all the documentation you can. Call the insurance company and ask for the denial rationale in writing and the criteria they used. Then appeal it. Go to getclaimable.com to see if we cover it. If you have an oncology issue, you can reach out to me directly. I will do my best to help. Don't take "no" for an answer.
Dr. Amar Rewari:
Finish this sentence: The biggest lie the insurance industry tells itself about prior authorization is?
Warris Bokhari:
It saves money.
Dr. Anthony Paravati:
Five years from now, does Claimable still exist because the problems are just as bad, or have you worked yourself out of a job?
Warris Bokhari:
I hope we work ourselves out of a job. The goal is to actually solve the problem.
Dr. Amar Rewari:
Where can our listeners find you and Claimable?
Warris Bokhari:
Getclaimable.com. You can find me on LinkedIn. I tend to be very responsive and spend a lot of time digging into cases to help families.
Dr. Anthony Paravati:
Warris, what a great conversation. You're doing important work. Thank you so much for your time and for joining us.
Warris Bokhari:
Thank you.
