How AI Is Disrupting Healthcare RCM and Exposing Insurance Claim Denials, With Reid Zeising, CEO of GAIN

Episode notes

In this episode, Michael sits down with Reid Zeising, CEO of GAIN, the largest revenue cycle management organization specializing in litigated and complex healthcare claims. The conversation pulls back the curtain on how healthcare providers struggle to get paid for services already delivered, and how technology and AI are being used to push back against decades of insurance-driven denial strategies. Reid explains how the insurance industry fundamentally changed in 1994, when Allstate introduced Colossus, a system designed to standardize and often suppress claim payouts in favor of shareholder value. That shift, he argues, still shapes today’s reimbursement environment, leaving providers underpaid and patients caught in the middle. Drawing on Michael’s background in primary care administration, the discussion highlights a stark reality: many healthcare organizations collect only a fraction of what they bill, even when care is medically necessary and properly delivered. Reid compares this to asking professionals to do full work for partial pay and explains why this model is unsustainable, especially for providers serving uninsured and underinsured populations.