On January 7, 2025, Dr. Elisabeth Potter was called out of a breast cancer surgery to justify her patient’s overnight stay to an insurance representative who did not have the medical records. The surgery was pre-approved. The stay was denied anyway.
Unchecked AI documents what happens when AI systems make decisions about people who never see the system: claims review, prior authorization, hiring, consent, lending, surveillance. Named incidents. Sourced numbers. No hype. And with each major piece, something you can use: the vendor questions, contract language, or checklist that would have caught the failure.
I’m Rachel Ankerholz. I manage technology infrastructure for a global academic community, and I write about who gets included, and who gets left behind, when we build systems. When my systems fail, there is an incident report and a board conversation. When these systems fail, there is a denial letter and a patient who gave up.
The series has drawn responses from technical peers, including a 4,000-word architectural reply to “Authorized, Operated, Denied” proposing how to make incoherent denials structurally impossible. It also produced Overturned, a free tool that generates an appeal letter from your denial documents. No login, no storage of your records: rachelankerholz.com/tools/overturned.
If someone you love has ever received a denial letter for care that was already approved, this newsletter is for you. If you buy, deploy, or answer for these systems, it is especially for you.
