Hardware Podcasts

#427: Medical Device Reimbursement - Pitfalls to Avoid

Global Medical Device Podcast · 6 Oct 2025 · 41m · Episode 427

AI in practice: one real use of AI described

What this episode covers

Haley King, co-founder and CEO of Paxos Health, explains the critical distinction between FDA approval and securing reimbursement, detailing the three pillars of coding, coverage, and payment. She highlights the challenge of navigating CPT codes, specifically the gap between temporary Category 3 codes and the gold-standard Category 1, and notes that securing Medicare coverage can take an average of 5.7 years for innovative devices. King discusses how AI tools are being used to streamline manual patient access tasks, such as prior authorizations and appeals, while emphasizing the necessity of keeping human experts in the loop for high-stakes decisions. The conversation covers the importance of designing clinical trials with payer requirements in mind to avoid costly delays and ensure commercial success.

AI in practice

Where this conversation describes AI being used to build or deliver a product. Part of the AI in practice tracker.

Marketing & salesPaxos Health (proprietary AI tool)

The AI tool automates the review of payer policies and patient clinical records to generate customized prior authorization arguments, reducing manual document review time and improving submission quality.

“we've built a tool that uses AI to try to eliminate those cumbersome tasks that … going through 100s of pages of medical documents … we automate that, but we set the interface up in a way so that the user has full visibility…”

Speaker 3 · Hear it at 24:55

Most relevant to

early-stage companies

Topics

Mentioned

Companies
Paxos Health, Medtronic, Cooler Heads Care, United Healthcare, Aetna
Also
CMS, Epic, Athena, ChatGPT, FDA, AMA

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