The 20-Year Denials Problem Ends Here: Why AI is the Future of Healthcare Claims Automation

Claim denials have cost U.S. providers billions for 20 years. Here’s why AI-driven automation is the breakthrough hospitals need now.

Introduction

For two decades, claim denials have been treated as an unavoidable obstacle. But hindrances don’t cost $600 billion annually. Dean Margolis, CEO of Red Sky Health, calls it what it is: “Across the industry, denials have been a 20-year headache — and it’s costing providers hundreds of billions each year.”

The Real Cost

Behind the numbers are human consequences. Denied claims can mean a nurse isn’t hired, a clinic is forced to merge, or a patient waits longer for care.

Margolis puts it in perspective: “When providers lose revenue, they’re not just losing numbers on a spreadsheet. They’re losing resources that directly affect patient access and outcomes.”

Why AI Matters Now

Manual fixes haven’t solved the problem. Billers rework denials by trial and error, rarely with consistent success. AI finally closes that loop.

“Daniel learns from every attempt,” Margolis explained. “It improves continuously, correcting and resubmitting faster than people ever could.”

The shift isn’t just operational — it’s cultural. For the first time, providers can trust that denied claims won’t languish for months.

Outcome-as-a-Service: A Model Built for Trust

Healthcare leaders don’t want another software invoice. They want measurable results. That’s why Red Sky Health delivers denial remediation as Outcome-as-a-Service.

“Executives only pay when reimbursement improves,” Margolis said. “That’s the model that makes sense for an industry already under financial stress.”

Conclusion

Denials have defined the last 20 years. AI-powered denial remediation has the potential to define the next 20 — turning revenue leakage into recovered dollars and reinvestment in patient care.

CTA: Book a demo and discover how AI can turn denials into dollars.