Inspiration
My aunt lost her house when she had breast cancer because couldn't afford the bills. She went into debt because insurance wouldn't pay.
81.7% of appealed Medicare Advantage denials get overturned but only 11.7% are ever appealed
Doctors and staff spend over 13 hours a week dealing with claim denials.
What it does
it reads claims/denial letters and compares them to our 120,000+ claim database, uses grok to create an appeal.
word coach to improve likelihood of approval
grok voice will even call the insurance provider
How we built it
- Stack: React + Vite frontend on a Skateboard shell, Hono + SQLite backend
- Intelligence: xAI Grok structures the analysis, plain-English explanation, Word Coach, and draft appeal from a curated RAG knowledge base of cancer denial patterns
- Voice: Grok Voice over a realtime WebSocket — server-minted ephemeral tokens, mic PCM16 streamed with server-side VAD and audio playback
- Demo data: A full Maria Santos packet (denial letter, prior auth, EOB, CMS-1500, weak vs. strong appeal drafts) plus real CMS-style PDFs, seeded on load; optional EMR import feeds medical records into the Grok analysis
Challenges we ran into
- Making Grok specific, not generic: the whole point is which words won — we had to inject appeal-strong patterns and contrastive coaching rather than letting it default to a polite-letter template.
- Domain accuracy: Medicare vs. Medicare Advantage vs. commercial plans handle prior auth completely differently.
Accomplishments that we're proud of
- A working Word Coach that shows weak → winning language, not just a generated letter
- Grok Voice that's a real accessibility feature, not a gimmick built for patients too overwhelmed to read dense letters
- An end-to-end demo: documents → one-click analyze → Analysis drawer → voice Q&A → copy-ready appeal
- Grounding every claim in real data (KFF/CMS, AMA, ProPublica's EviCore investigation) ## What we learned
- The 81.7%/11.7% gap is a UX problem, not a legal one: people don't appeal because the process is overwhelming, so voice + one-click matter more than legal sophistication.
- its not the denial it's the delay. people often die because of the insurance approval delays
What's next for claim decline assistant
- Auto-fax/portal submission so the appeal actually files itself, not just drafts.
- Deadline tracking + reminders (appeals have hard windows that patients miss).
- EMR/payer API integrations (FHIR) to pull records automatically instead of manual import.
- Expand the knowledge base beyond cancer to all high-denial specialties.
- Outcome tracking loop — feed real approve/deny results back to sharpen the Word Coach.
- HIPAA compliance + provider/patient-advocate pilot.
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