RECOURSE
Denied isn't final.
An AI advocate that reads your insurance denial, tells you your odds, and fights back for you — in about three minutes.
AI Product Prototype | Hackathon Submission
1 / 10
PROBLEM STATEMENT
Insurers count on you giving up.
Health insurance denials are common, confusing by design, and almost never challenged — even when the claim is legitimate.
1 in 5
health insurance claims are denied
<1%
of denied claims are ever appealed
180 days
typical appeal window — easy to miss
Not because they're wrong — because the process is exhausting.
Dense jargon, alphanumeric billing codes, buried deadlines, and a power imbalance: one side has a legal team, the other has a stack of paperwork they don't understand.
2 / 10
SOLUTION OVERVIEW
One pipeline, from denial to appeal.
Recourse reads the actual document, reasons about it, and produces the exact artifacts a person needs to fight back.
Upload
Photo or PDF of the denial / EOB
→
Read
AI vision transcribes it directly
→
Diagnose
Plain-English translation + odds score
→
Draft
Formal, policy-cited appeal letter
→
Track & Escalate
Deadline reminder + HR brief
Everything above runs on real, arbitrary input — not a scripted demo with one hardcoded letter.
3 / 10
TARGET USERS
Built for the person holding the letter.
Individual patients & families
Anyone who received a denial or a confusing EOB and doesn't know if — or how — to fight it.
Employees on group health plans
Workers whose employer's HR team has leverage with the insurer that they don't have alone.
Caregivers of aging parents
People navigating Medicare/Medicaid denials on behalf of someone else, often under time pressure.
HR & benefits teams (B2B)
Employers who want to offer claims advocacy as a wellness benefit that cuts stress and absenteeism.
4 / 10
PRODUCT FEATURES
Five tools, one case file.
EOB & Denial Translator
Vision-based OCR reads photos or PDFs directly and decodes CPT/ICD-10 and denial codes into plain English.
One-Click Appeal Generator
A formal, policy-cited appeal letter drafted from the specific weakness found in the insurer's own reasoning.
Success Predictor
A calibrated 0–100 score estimating how winnable the appeal is, with the reasoning shown, not just a number.
Deadline Tracker
Extracts the filing deadline and generates a real calendar file with a 14-day reminder, plus follow-up templates.
HR Escalation Toolkit
A data-backed executive brief employees can hand to HR, leveraging the employer's group-plan standing.
5 / 10
TECHNICAL ARCHITECTURE
Thin client, model-native backend.
No custom OCR service, no ML training pipeline — the model does the heavy lifting directly.
Client (Browser)
HTML / CSS / vanilla JavaScript UI. pdf.js renders uploaded PDF pages to images client-side.
↓
Serverless Proxy
A minimal Node.js function holds the API key server-side and forwards requests — the key is never exposed to the browser.
↓
Claude API
Vision transcription, structured JSON extraction, and generation — one model, four distinct tasks.
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Generated Artifacts
Appeal letter, diagnosis, .ics calendar file, and HR brief — all produced live, nothing pre-written.
6 / 10
AI TECHNOLOGIES USED
One model, used four different ways.
Vision-based transcription
Claude reads uploaded images/PDF pages directly as OCR — no separate vendor, works on messy scans.
Structured extraction
A single call returns strict JSON: plain-language summary, decoded codes, category, weakness, and score.
Constrained generation
Appeal letters, follow-ups, and HR briefs generated in a fixed professional register, grounded in the diagnosis.
Calibrated scoring
The success score is reasoned against denial category patterns, not a free-floating guess.
7 / 10
IMPACT & VALUE PROPOSITION
We only get paid when you do.
Billions of dollars in legitimately owed claims go unclaimed each year purely from friction. Recourse converts that friction into a three-minute task.
Contingency model
10–15% success fee on money actually recovered — zero upfront cost to the person.
Flat-fee delivery
$19–$49 for concierge certified-mail/fax delivery of the full appeal bundle.
B2B benefits channel
Sold to employers as a wellness benefit that reduces billing-dispute stress and absenteeism.
Consumer pain + high-frequency event + clear willingness to pay on success = a large, defensible market.
8 / 10
FUTURE ROADMAP
From reasoning to precedent.
01
Precedent database
Connect denial codes to real won-appeal arguments, ERISA case law, and state insurance rulings.
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02
Real payments & delivery
Stripe for success/flat fees; Lob or PostGrid for actual certified mail and fax delivery.
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03
Outcome tracking
Close the loop — learn which arguments actually win with which insurers, and improve scoring.
→
04
Beyond health insurance
Extend the same pipeline to auto, home, and warranty denials, where the same broken dynamic exists.
9 / 10
Denied isn't final.
Recourse turns a denial letter into a fight — in about three minutes.
Thank you.
10 / 10