A growing concern for people in New York is how artificial intelligence is used in many aspects of everyday life. An area where it is particularly worrisome is in healthcare. When insurance providers use AI to deny care, it can cause problems.
Insurance companies warned not to use AI to deny care
The Centers for Medicare & Medicaid Services has warned health insurers not to use AI or algorithms to analyze a case and determine whether to approve or deny care. A memo was sent to clarify the rules for people who have Medicare Advantage.
Many lawsuits have accused insurance companies of using AI to justify denying claims. These were primarily done when caring for elderly people with Medicare Advantage.
Companies use their version of AI – nH Predict – to make these decisions. It is believed to be manipulated to minimize how long a person needs hospitalization, nursing home care and rehabilitation. The software is not gauging the entire case on an individual basis. Instead, it looks at relatively few factors for its decision.
This does not mean that using AI should stop. It means insurers can only use it to ensure they adhere to the rules. With elder law, this can be viewed as a fine line that insurance companies might try to use to deny claims.
Questionable insurance denials must be scrutinized
People who are denied care or do not have the amount of care they believe was necessary because of AI-based formulas should make sure they are treated fairly. Since this can result in worsened condition, injuries, illness and even death, people should be aware of what options are available to hold those who used these tactics accountable.