AI-Driven Denials of Medical Coverage Leave Patients Vulnerable

Private health insurers in the US are increasingly relying on artificial intelligence (AI) to make decisions about patients' medical claims, but critics say this can lead to arbitrary and potentially life-threatening denials of coverage.

UnitedHealth Group, the largest health insurer in the country, is facing a class-action lawsuit over allegations that its AI system, nH Predict, denied coverage to elderly patients who needed extended nursing home stays. The company allegedly uses the AI model to predict patients' future health and make decisions about claims without human oversight.

Patients and their families are left in the dark as to why their claims are being denied, and appeals often lead nowhere. In one case, a 91-year-old patient was denied coverage for nursing home care after just two weeks of rehab, despite his doctor's recommendations. The patient eventually died at the facility, with his family forced to pay thousands of dollars out-of-pocket.

Experts say that AI programs like nH Predict are not always accurate and can perpetuate systemic biases in healthcare. They also argue that relying on AI to make decisions about patients' care can lead to a loss of the human touch in medicine.