IndieBug

ClaimShield is a patient-side AI claim auditor for Indian health insurance, built on Meta Muse Spark. Scale: Insurers issued 2.68 crore policies, covering 57 crore lives. Problem: Of the Rs 1.17 lakh crore worth of claims filed, only Rs 83,493.17 crore (71.29 per cent) was paid. Claims worth Rs 26,037.65 crore were rejected in FY23-24. Unfair cuts: Over five in ten health insurance policy owners who had a claim said the insurer rejected it or only partially approved it for invalid reasons. Root cause: Room-rent caps, proportionate deductions, non-payable items, waiting periods, billing errors and missing documents. Families discover these only after discharge, when the bill can no longer be fixed. Solution: Upload the policy and hospital bill (PDF, scan or photo). ClaimShield checks every line against the policy and IRDAI rules, predicts each deduction before the insurer does, tells you what to fix and who to ask, and drafts the appeal if the claim is rejected. Three stages: Still in hospital, about to file, rejected or short-paid. Impact example: A ₹71,350 cataract claim goes from ₹44,370 to ₹59,130 after fixes. A wrongful pre-existing-disease rejection shows ₹2,56,000 recoverable. Accessible: 12 Indian languages, voice and photo input, offline mode, personal data masked. Open source, evaluated on 36 labelled claims, 157 automated tests.