How UnitedHealthcare and other insurers use AI to deny claims

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Posted on 12/08/2024 7:12:57 AM PST by TigerClaws

The fatal shooting of UnitedHealthcare (UNH) CEO Brian Thompson on Wednesday has sparked public scrutiny of health insurers, especially regarding their use of AI in evaluating claims. The incident also comes as several insurance providers have been facing litigation over their coverage practices and the potential impact they have on patient care.

Thompson was fatally shot in New York City on Wednesday morning, just hours before he was set to speak at the insurance firm’s annual investor day.

Multiple outlets reported on Thursday that shell casings from the shooting had the words “deny,” “defend,” and “depose” written on them. The words appear to reference terms industry critics use to describe how insurers deny claims.

At the same time, posts on social media have been claiming that UnitedHealthcare’s claim-denial rate is the highest in the industry; however, since insurers try to keep these numbers hidden, the true extent of its denials remains uncertain, especially when it comes to private plans.

Still, some recent reports show that denials for some patients have been on the rise.

In October, a report from the U.S. Senate Permanent Subcommittee on Investigations showed that the nation’s insurers have been using AI-powered tools to deny some claims from Medicare Advantage plan subscribers.

The report found that UnitedHealthcare’s denial rate for post-acute care — health care needed to transition people out of hospitals and back into their homes — for people with Medicare Advantage plans rose to 22.7% in 2022, from 10.9% in 2020. Advertisement

The rise coincides with UnitedHealthcare’s implementation of an AI model called nH Predict, originally developed by naviHealth, a subsidiary of UnitedHealth Group that has since been rebranded.

(Excerpt) Read more at yahoo.com ...

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1 posted on 12/08/2024 7:12:57 AM PST by TigerClaws

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