Privacy Policy

When you create an account or use the Service, you may provide:

• Account information: name (first name and last initial), email address, and password.
• Demographic information: age, biological sex, gender identity, race/ethnicity, height, weight, ZIP code, and pregnancy status — collected to personalize cost estimates and care recommendations.
• Health and symptom information: symptoms, symptom severity, duration, urgency level, and free-text descriptions of your health situation.
• Diagnosis and medical history: existing diagnoses, suspected conditions, chronic conditions, past major diagnoses, family history, and prior tests or imaging.
• Prescription drug information: medication names, dosages, and frequencies.
• Insurance information: insurance provider name, plan name, group number, member ID, payer ID, and insurance card images.
• Primary care physician (PCP) information: name and office address.
• Insurance documents: Explanation of Benefits (EOB) documents, medical bills, receipts, and other supporting documents you upload.
• Insurance call notes: outcome summaries and notes you enter after calling your insurance company.
• Care preferences: preferences such as lowest cost, closest provider, or soonest appointment.

• Usage data: pages visited, features used, buttons clicked, and session duration.
• Device and browser information: device type, operating system, browser type and version, and screen resolution.
• Aggregate analytics: non-personally-identifiable metrics such as upload counts, feature engagement rates, and funnel drop-off points.
• Audit logs: hashed (SHA-256) user identifiers, action types (e.g., file access, form generated, PDF generated), and non-PHI metadata about events — used for security and compliance auditing. Audit logs do not store PHI.

• AI-generated analysis: cost estimates, care setting recommendations, appeal letter content, denial reason analysis, and form pre-fill data generated by large language models (LLMs) based on your inputs.
• Document extraction data: structured data fields extracted from uploaded EOBs and medical bills (e.g., claim numbers, billed amounts, procedure codes, denial reasons).
• Experiment cohort assignments: anonymized A/B test group assignments used to improve Service design.

• We do not collect Social Security Numbers.
• We do not collect payment card numbers or billing information directly (payments, if applicable, are processed by PCI-compliant third-party processors).
• We do not collect or access your electronic health records (EHR) without your explicit action.

• Generate personalized care setting recommendations (primary care, urgent care, specialist, emergency room) based on your symptoms and health inputs.
• Estimate healthcare costs and out-of-pocket expenses based on your insurance plan and demographic profile.
• Extract and analyze data from uploaded insurance documents to identify reimbursement opportunities, missed claims, and denial patterns.
• Generate appeal letters, claim forms, and supporting documentation.
• Provide Insurance Call Copilot scripts and post-call outcome tracking.
• Support TennCare/Medicaid-specific appeal workflows.

ClaimNav uses large language models (LLMs) operated by third-party AI providers to generate recommendations, explanations, and documents. Before any data is sent to an LLM, we apply de-identification measures, including:

• Removing direct identifiers such as patient names, member IDs, and dates of birth from LLM prompts.
• Sending only clinical and financial fields required for the analysis (e.g., procedure codes, amounts, denial reasons) — not your name or contact information.
• Using server-side PHI redaction (regex-based pattern scrubbing covering SSNs, phone numbers, email addresses, physical addresses, dates, and insurance IDs) on all free-text fields before they are stored or transmitted.
• Injecting prompt-injection-resistant delimiters around user-provided free-text to prevent instruction override attacks.

AI-generated outputs are advisory only and do not constitute medical, legal, or financial advice. See Section 8 for full details.

• Analyze aggregated, de-identified usage patterns to improve features and recommendation accuracy.
• Conduct A/B testing to evaluate different user experience approaches.
• Monitor appeal success rates and claim outcomes in aggregate to refine guidance quality.

• Maintain tamper-evident audit logs of access and mutation events for PHI-adjacent entities.
• Detect unauthorized access attempts and anomalous usage patterns.
• Comply with applicable legal obligations.

• Send transactional notifications related to your account, claims, and follow-up reminders.
• Send product updates and feature announcements (you may opt out at any time).

We share information with third-party vendors who help us operate the Service:

• Cloud infrastructure and database hosting: your data is stored on servers managed by our platform provider (Base44). Data is encrypted at rest and in transit.
• AI / LLM providers: de-identified and sanitized data is sent to AI model providers (e.g., OpenAI, Google, Anthropic) to generate recommendations and documents. We contractually require these providers not to use your data to train their models.
• Document storage: uploaded files (EOBs, insurance cards, medical documents) are stored in private, encrypted object storage. Access requires time-limited signed URLs and cannot be retrieved via public URLs.
• Email delivery: transactional emails are sent via third-party email service providers.
• Analytics: aggregated, de-identified usage data may be shared with analytics platforms.

All service providers are contractually required to use your information only to provide services to us and to maintain appropriate security measures.

We may disclose your information if required to do so by law or in response to:

• A valid subpoena, court order, or other legal process.
• A request from a government authority in connection with a law enforcement investigation.
• A situation where we believe in good faith that disclosure is necessary to prevent imminent harm, fraud, or illegal activity.

If ClaimNav is involved in a merger, acquisition, or sale of all or substantially all of its assets, your information may be transferred as part of that transaction. We will notify you via email and/or a prominent notice within the Service of any such change and any choices you may have regarding your information.

We will share your information with any third party for purposes other than those described above only with your explicit, informed consent.

• Advertisers or data brokers.
• Your insurance company, employer, or healthcare provider (unless you explicitly generate and submit a document yourself).
• Any party for purposes of targeted advertising based on health data.

• Encryption in transit: all data transmitted between your device and our servers is encrypted using TLS 1.2 or higher.
• Encryption at rest: all stored data, including uploaded documents, is encrypted at rest.
• Private file storage: uploaded documents are stored in private buckets inaccessible via public URL. Access is gated by time-limited signed URLs (expiring within 5 minutes) generated only upon authenticated request.
• Authentication: access to the Service requires account authentication. All backend API endpoints enforce authentication checks and return 401 or 403 errors on unauthorized requests.
• Authorization: ownership checks are enforced on all resource-access operations (e.g., a user can only access their own claims, documents, and submissions). The same error message is returned for "not found" and "unauthorized" to prevent ID enumeration attacks.
• PHI redaction: server-side regex-based scrubbing is applied to all free-text fields (call notes, user descriptions) before storage. Patterns covered include SSNs, phone numbers, email addresses, physical addresses, dates, member IDs, and credit card numbers.
• LLM de-identification: direct identifiers are stripped from all AI prompts before transmission to third-party LLM providers.
• Prompt injection mitigation: user-supplied free-text is sanitized against known prompt injection patterns and enclosed in semantic delimiters in AI prompts.
• Audit logging: all PHI-adjacent access and mutation events are logged with hashed (SHA-256, non-reversible) user identifiers and non-PHI metadata.

• Access to production data is limited to authorized personnel on a need-to-know basis.
• We conduct ongoing review of security practices as the Service evolves.

No method of electronic transmission or storage is 100% secure. While we implement commercially reasonable safeguards, we cannot guarantee absolute security. In the event of a data breach that affects your personal information, we will notify you as required by applicable law.

You have the right to request a copy of the personal information we hold about you. You can access much of your information directly within the Service (Account page, Recent Searches, Claims history).

You may update or correct your account information, demographic profile, and insurance details at any time through the Account settings page within the Service.

You may request deletion of your account and associated personal data by contacting us at privacy@claimnav.com. Upon verified request, we will delete or de-identify your personal information within 30 days, except where retention is required by law or legitimate business necessity (e.g., audit logs required for compliance).

Note: deleting your account will permanently delete your claims history, uploaded documents, and assessment records and cannot be undone.

You may request a machine-readable export of your personal data by contacting us at the address below.

You may opt out of non-transactional communications (e.g., product updates) by clicking the "Unsubscribe" link in any such email or by contacting us directly.

If you are a California resident, you may have additional rights under the California Consumer Privacy Act (CCPA), including the right to know what personal information is collected, the right to delete, the right to opt out of sale (we do not sell personal information), and the right to non-discrimination for exercising your rights. To exercise these rights, contact us at privacy@claimnav.com.

Tennessee residents using TennCare/Medicaid-related features should be aware that ClaimNav is an independent advisory tool and is not affiliated with TennCare, the Tennessee Bureau of TennCare, or any Managed Care Organization (MCO). We do not share your information with TennCare or any MCO.