Hospitals Are Reporting More Insurance Denials. Is AI Driving Them?
by Alexis Kayser, Healthcare Editor at Newsweek
It's hard to nail down exactly when insurance companies began implementing AI tools; they tend to be vague about internal automation processes. But multiple health care and tech leaders who spoke with Newsweek began noticing accelerated claims denials between 2019 and 2020.
The lawsuits came years later, but in quick succession. In July 2023, Cigna was hit with a class action lawsuit over an algorithm that reportedly rejected more than 300,000 claims in two months—spending about 1.2 seconds on each. A second, similar suit was filed against the company the next month.
In November 2023, a lawsuit against UnitedHealthcare claimed that the company deployed an AI tool developed by NaviHealth (itself an arm of the company's health services business, Optum) to deny care to elderly Medicare Advantage (MA) beneficiaries. Weeks later, Humana was served papers for allegedly utilizing the same NaviHealth tool, which had a known 90 percent error rate, according to the initial lawsuit.
