Insurance Companies Are Relying on AI to Process Medical Claims
For many years, going back to the beginnings of medical insurance in this country, processing claims relied on human expertise and analysis. Now, things are changing. A growing number of insurance companies use Artificial Intelligence (AI) to help process medical insurance claims. Some class action court cases have recently been filed questioning the denial of medical claim payments when AI was used. CBS News reported a class action case against the insurance carrier Cigna in California. The plaintiffs claimed that Cigna's algorithm, PxDx, was used to save the company money and time by denying payments without conducting a thorough, fair, and objective investigation of the claim. A similar Minnesota lawsuit against United HealthCare involved elderly patients using a Medicare Advantage plan who claimed they were denied medical claim coverage and compensation for post-acute care due to the use of a flawed AI model.
In June of 2023, an American Medical Association Board Member, Marilyn Heine, stated that AI speeds up authorizations, but insurers needed to require human examination of the patient's records before a denial of care: “AI is not a silver bullet.”
Your Insurance Company May Not Be Doing a Thorough Review of Your Claim
If you feel that your insurance company has unfairly denied your medical claim, have your claim reviewed by experienced attorneys who can help you recover what you deserve, not just what an AI algorithm says you should recover. In the United Healthcare case, it was reported that the AI had a 90% error rate. However, it was still used to deny claims because the health insurance company knew that only a tiny percent of policyholders would appeal a claim denial. However, that small percentage was 90 % successful on appeal.
If you have been injured or denied what you feel is a legitimate claim for compensation for your medical claims, contact the experienced personal injury attorneys at Ackerman & Falcon, who will help you fight back. Call us today at 703-288-1400 for a free consultation, or contact us online.
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