How Health Insurers Are Using AI to Deny Your Claims

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How Health Insurers Are Using AI to Deny Your Claims

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In this episode of Services Economy with Fexingo, Lucas and Luna dive into the growing role of artificial intelligence in health insurance claims processing. They explore how insurers like UnitedHealth Group and Anthem are deploying AI algorithms to automate claim reviews and prior authorization decisions, often resulting in higher denial rates. The hosts examine a specific case where a proprietary AI system called 'nH Predict' was shown to deny care at twice the rate of human reviewers, leading to a class-action lawsuit. They discuss the regulatory landscape, including a recent CMS rule requiring human oversight of AI decisions in Medicare Advantage, and what this means for patients and providers. The episode also touches on the broader trend of algorithmic gatekeeping in healthcare, the lack of transparency around these AI tools, and the growing push for algorithmic accountability. Tune in for a nuanced conversation about how machine learning is reshaping the business of health insurance — and not always for the better. #HealthInsurance #AI #ClaimsDenial #PriorAuthorization #UnitedHealthGroup #Anthem #nHPredict #AlgorithmicAccountability #CMS #MedicareAdvantage #Healthcare #ServicesEconomy #FexingoBusiness #BusinessPodcast #Economics #InsuranceTech #PatientRights #Regulation Keep every episode free: buymeacoffee.com/fexingo

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