A pilot program testing the use of artificial intelligence to expand prior authorization decisions in Medicare has providers, politicians and researchers asking questions.
  • N0t_5ure@lemmy.world
    1·
    8 days ago

    As an insurance coverage attorney, I can’t tell you how disturbing the use of AI is with respect to claims handling. In State Farm Mutual Automobile Insurance Company v. Campbell, litigation that lasted over two decades, it was shown that State Farm’s claims handling system was effectively designed to low-ball claims, with the court noting that State Farm created “a national scheme to meet corporate fiscal goals by capping payouts on claims company wide.”

    You can absolutely 100% expect that there will be insurers that use AI trained on data sets that will cause them to disproportionately deny claims by design. Insurer profit margins lie between the premiums they take in and the claims that they pay out, and the goal of all corporations is to maximize shareholder profits. Those who do it will gain a competitive advantage, which will incentivize others to follow suit and U.S. healthcare will get even worse.

    • AA5B@lemmy.world
      1·
      7 days ago

      Yeah the difference between reality and corporate greed is as someone who works with various flavors of ai, they absolutely could help insurers lower costs without impacting customers. In this ideal world the AI would only be used to approve claims. Most claims are approved so why are we wasting an adjuster’s time when we can just make it so? Most cases could sale through smoothly with no human intervention. Then fewer adjusters could spend more time on more complex cases. Win-win. Of course in the real world we know corporate greed will focus on denying as many claims as possible

  • DaddleDew@lemmy.world
    1·
    8 days ago

    People will die. Someone will eventually sue them. They will lose but they don’t care they will have made more money letting people die than what the penalty will be.