Overturn
A model writes an appeal citing the insurer’s own policy, and a second model tries to tear it apart before any human reads it. Then the case waits, weeks, if it has to, and escalates itself to the next appeal level the moment the payer goes quiet, with no person and no process running in between.
StartMarketplace insurers denied about 85 million in-network claims in 2024. Consumers appealed at least 262,982 of them — fewer than one in three hundred. Even then, insurers upheld 66% of the appeals they received. KFF, ACA Marketplace claims data, 2024. The bottleneck is not judgement. It is that the labour cost of one appeal exceeds the value of one claim, on odds that already look bad before anyone accounts for the labour. Of the eight cases in this evaluation, four correctly produced no appeal at all — a quarantine, two declines for lack of a basis, one safety cap holding on a hard input — and refusing to appeal what shouldn't be appealed is the pitch, not overhead to hide. Against the four that did, Overturn's measured cost was roughly eleven model calls per appeal produced (44 calls total across all eight cases ÷ 4 that actually produced one; see docs/EVALUATION.md).