Cliché image of AI bot

The First AI Bot Wars…

On one side, AI used by US insurances to deny claims; the other, physicians using AI to appeal the denials.

“Behind the scenes, insurers are using unregulated predictive algorithms, under the guise of scientific rigor, to pinpoint the precise moment when they can plausibly cut off payment for an older patient’s treatment.” 

Wonderful… 😳

In March 2023, STAT published an investigative article on the use of algorithms to deny claims within the Medicare Advantage program. The examples they pointed out were dramatic (I posted a link in the comments below).

The overall tone of the article goes like this: an elderly patient is denied a claim or forced to be released prematurely. The patient can appeal (with the help of the care team), but it takes a lot of time, emotional energy, and effort to complete it—all things elderly patients are in short supply.

Enter AI to automate pre-approvals and appeals to these denials. 🤖

Some companies have launched AI-based products to provide this automation, Doximity being one example. The idea predates the introduction of ChatGPT, but with it entering the mainstream, these types of platforms should become more common.

We will soon be in a world where we will see more AI vs. AI scenarios. Without good ethical and regulatory guardrails in place, these matchups could lead some very unwanted consequences.

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