Becker’s Healthcare Podcast Fighting Denials and Leading with Purpose in Healthcare with Ed Norwood
Mar 29, 2026
A mix of healthcare advocacy and tech strategy, from fighting payer denials with regulatory tactics to using AI to predict and automate appeals. Stories include winning major settlements and protecting patient access through smarter contracts. Leadership themes cover overcoming generational fears, building intentional culture, and a five-point exercise to clarify purpose and legacy.
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Weekend Regulatory Win Saved Teen's Surgery
- Ed Norwood described a Saturday-to-Monday intervention that overturned an ERISA plan denial for a 17-year-old with a brain tumor.
- He challenged the plan reviewer’s competence under 29 CFR 2560.503 and secured surgery the next week, saving the patient from seizures and shoulder dislocations.
Regulators Push Back On Fully Automated Denials
- AI-driven payer denials are increasing while regulators demand clinician involvement in automated decisions.
- California SB 1120 and a 2024 CMS memo require licensed clinicians and individualized clinical history for algorithmic medical necessity determinations.
Train Humans To Oversee AI Tools
- Train staff to become human experts who oversee AI and identify knowledge gaps to prevent algorithmic drift.
- Use AI for repetitive tasks but keep humans to mentor, validate, and correct outputs as tools accelerate revenue cycle work.
