Stateline reports health insurance companies are facing “scrutiny for allegedly using artificial intelligence bots and algorithms to swiftly deny patients routine or lifesaving care” without a human reviewing the claims. Lawmakers in in more than a dozen states are considering legislation to limit the use of AI in reviewing claims; exclude certain prescription medications from prior authorization rules; ensure that emergency mental health care is not delayed for more than 48 hours; and require that insurers’ review boards include licensed physicians, dentists or pharmacists with clinical experience. Insurers say that prior authorization is needed to limit unnecessary services while doctors say that it causes delays in necessary care and harms patients. Health insurance companies are under increasing scrutiny for allegedly using artificial intelligence bots and algorithms to swiftly deny patients routine or lifesaving care — without a human actually reviewing their claims.
There had been protests and outrage over UnitedHeathcare’s prior authorization practices months before the high-profile murder of CEO Brian Thompson. However, his killing has focused even more attention on the prior authorization process. UnitedHealthcare has been accused in a class-action lawsuit of using AI to wrongfully deny claims. Read the complete article for more details on what individual states are doing to push back.
Related posts
- Artificial Intelligence vs Augmented Intelligence in Prior Authorization Denials – Caroline Fife M.D.
- Insurers Continue AI Claims Automation Despite Legal Challenges – Caroline Fife M.D.
- The Kafkaesque Challenge of Medicare Advantage Prior Authorization – Caroline Fife M.D.
