Insurance Claims AI Guardrail Demo
In 2023-2026, class-action lawsuits revealed that AI algorithms were denying Medicare claims with a 90% error rate, often overriding physician recommendations. This demo shows how AxiomGuard can prevent algorithmic harm by enforcing deterministic rules that protect vulnerable patients.
90%
AI denial error rate
UnitedHealth lawsuit findings
13 sec
Average review time
Per claim before denial
147K+
Patients affected
In pending class actions
APPROVE
Claim meets medical necessity
DENY
Does not meet criteria
HUMAN REVIEW
Requires clinical judgment
Claims Processing Simulation
Configure a Medicare/insurance claim scenario and see how AxiomGuard intervenes when AI algorithms attempt harmful denials. Watch for guardrail overrides that protect patients.
Post-surgical skilled nursing care following hip replacement. Patient requires daily wound care, PT supervision, and medication management.
AxiomGuard Decision
Configure claim and click Process
How AxiomGuard Prevents Algorithmic Harm
Mortality Risk Protection
High-acuity patients are never auto-denied. Deterministic rules ensure human review for life-threatening conditions.
Hospice Benefit Enforcement
End-of-life care claims are protected from cost-optimization algorithms. Federal hospice rules are enforced deterministically.
Continuity of Care Rules
Patients mid-treatment cannot be abruptly denied. State continuity-of-care regulations are checked on every claim.
Audit Trail for Appeals
Every decision is logged with rule citations, enabling patients and attorneys to challenge improper denials.
Medical Necessity Scoring
Clinical indicators are weighted deterministically, not just cost factors. AI cannot override medical judgment.
Escalation Triggers
Complex cases automatically escalate to human review. AI recommendations alone are never sufficient for denial.
Based on Real Cases
This demo is inspired by the class-action lawsuits against UnitedHealth regarding their nH Predict algorithm, which was found to deny medically necessary care to elderly patients at a 90% error rate. AxiomGuard demonstrates how deterministic guardrails could have prevented this algorithmic harm.