• Tue. Mar 5th, 2024

Unraveling the Mystery: Insights on AI-Driven Denial of Health Insurance Claims


Feb 13, 2024
Remove Artificial Intelligence from my healthcare

On February 6th, the US government issued a memo to Medicare insurers, clarifying that AI cannot be used as the sole basis for denying claims. While machine-learning algorithms can assist in making determinations, they cannot make decisions on their own. This memo comes in response to lawsuits against health insurers, such as United Healthcare and Humana, who have been accused of using AI to wrongly deny coverage. Patients claim that the AI model nHPredict has a 90% error rate, highlighting a dangerous aspect of the technology that is receiving increased attention. The Centers for Medicare & Medicaid Services expressed concern about the potential for algorithms to exacerbate discrimination and bias and have urged insurers to ensure their models comply with anti-discrimination requirements. Several states, including New York and California, have also warned insurance companies to verify the fairness of their algorithms.

In light of this memo, you may be wondering what happened with your insurance claim after you suffered a fall and broke an arm. Despite being covered by insurance, your claim was denied leaving you feeling frustrated and unsure if it was a person or an AI that made the decision. It’s important to note that while AI can assist in making determinations, they cannot make decisions on their own.

As someone who has experienced firsthand the challenges of dealing with insurance claims and denied coverage, you may be wondering what steps you can take next. One option is to appeal the decision and provide additional evidence or documentation that could change the outcome of your claim. It’s also important to understand your rights as a patient under your insurance plan and seek legal advice if necessary. Additionally, it’s crucial for patients to advocate for themselves when dealing with insurance issues and ensure their voices are heard in order to protect themselves from unfair denials or delays in coverage.

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