Healthcare Denial Explainer Tool (HCDT)

Insurance Denials Are Confusing & Frustrating:

When a health insurance claim is denied, members receive an EOB document filled with codes, legal language, and jargon that is nearly impossible to decode without industry knowledge. The result:

The Original Tool: Built Inside the Health Insurance Industry:

During my tenure managing digital products for one of the nation's largest health insurance associations, I identified this gap and built an internal tool to help members navigate denial explanations — translating complex insurance language into clear, actionable guidance.

That tool worked. It reduced member confusion, decreased unnecessary call volume, and empowered members to take action on their own behalf.

The HCDT is the next evolution of that idea — rebuilt from the ground up with AI at its core.

Executive Summary:

One of the most frustrating moments in American healthcare happens millions of times a year: a customer receives an Explanation of Benefits (EOB) and has no idea what it means, why their claim was denied, or what they can do about it.

One course of action is to have the customer call a CSR for help and to get an explanation .  This flow cost time for both the customer and CSR, and is an expanse for the company who has to provide the CRM for the CSRs and alike.

The Healthcare Denial Explainer Tool (HCDT) was designed to solve exactly that problem — in plain language, at the moment the patient needs it most.

This is not a hypothetical concept. It is a reimagination of a tool originally built during my tenure managing digital products for one of the nation's largest health insurance associations — now redesigned as an AI-powered, cusotmer-centered digital experience developed in active collaboration with Claude AI (Anthropic).

The HCDT: Reimagined with AI

The Healthcare Denial Explainer Tool (HCDT) is a patient-facing digital experience that guides users through an insurance denial — step by step, in plain language — and tells them exactly what they can do about it.

Developed as an innovation project in active collaboration with Claude AI (Anthropic), the HCDT transforms a confusing EOB into a clear action plan.

How it works:

• The member arrives after receiving an EOB that shows insurance didn't pay

• They identify their denial type: prior authorization, out of network, deductible, or not covered

• The tool explains what happened — using plain language and real-world analogies

• It shows the member what they likely owe — and whether it's fixable

• It walks them through three resolution paths: Late Approval, Negotiation, or Appeal

• It provides call scripts, calendar reminders, and step-by-step instructions

• At any point, a human chat or phone agent is one tap away

The HCDT is designed across 11 screens with full decision-tree logic, covering the complete member journey from confusion to resolution — including prevention tips to avoid future denials.

Built in Collaboration with Claude AI (Anthropic):

The HCDT is a personal innovation project — a deliberate experiment in AI-assisted product development.

Every screen, decision path, user flow, and piece of copy in this tool has been developed through an active, ongoing partnership with Claude AI (Anthropic) — one of the world's leading AI assistants.

This project demonstrates not just what I know about healthcare and product design, but how I work with AI tools to accelerate, sharpen, and scale that expertise.

For clients in healthcare and government who are asking how AI fits into their product and systems strategy — this is a live answer.

Where We Are Now:

The HCDT is currently in active development. The full user experience — including all 11 screens, decision logic, and resolution pathways — has been mapped and designed.

Next phases include: UI prototyping, AI model integration for personalized denial explanations, and partnership exploration with healthcare organizations and insurers.

Interested in this tool? Let's talk.

Collaboration with Claude AI