How AI Is Disrupting Healthcare RCM and Exposing Insurance Claim Denials, With Reid Zeising, CEO of скачать в хорошем качестве

How AI Is Disrupting Healthcare RCM and Exposing Insurance Claim Denials, With Reid Zeising, CEO of

Source: https://www.podbean.com/eau/pb-27h42-... In this episode, Michael sits down with Reid Zeising, CEO of GAIN, the largest revenue cycle management organization specializing in litigated and complex healthcare claims. The conversation pulls back the curtain on how healthcare providers struggle to get paid for services already delivered, and how technology and AI are being used to push back against decades of insurance-driven denial strategies. Reid explains how the insurance industry fundamentally changed in 1994, when Allstate introduced Colossus, a system designed to standardize and often suppress claim payouts in favor of shareholder value. That shift, he argues, still shapes today’s reimbursement environment, leaving providers underpaid and patients caught in the middle. Drawing on Michael’s background in primary care administration, the discussion highlights a stark reality: many healthcare organizations collect only a fraction of what they bill, even when care is medically necessary and properly delivered. Reid compares this to asking professionals to do full work for partial pay and explains why this model is unsustainable, especially for providers serving uninsured and underinsured populations. The conversation then turns to how GAIN is using AI, predictive analytics, and technology-enabled workflows to reverse that imbalance. By focusing on litigated and complex claims, GAIN helps providers recover fair compensation, improve cash flow, and continue offering care to communities that need it most. Reid also shares why his company intentionally shifted away from higher-margin claim financing toward a service-driven model built around access, transparency, and long-term system impact. Michael and Reid also explore the broader healthcare landscape, including the financial strain on providers, the coming “silver tsunami” of aging patients, and the consequences of tort reform on patient access to care. Reid challenges common insurance-industry narratives around “frivolous lawsuits,” explaining how language and lobbying efforts have been used to restrict legitimate claims and reduce accountability. The episode closes with Reid’s advocacy work through Americans for Patient Access and Americans for Responsible Consumer Funding, organizations focused on protecting access to healthcare and helping individuals navigate overwhelming medical and financial challenges. This is a candid, systems-level conversation about healthcare economics, AI-driven disruption, and what it will take to ensure providers get paid and patients get care. https://gainservicing.com/   / reidzeising