4sight Health February 25, 2025
Multiple media outlets, led by the investigative reporting of Bob Herman and Casey Ross at Stat, along with a report from the U.S. Senate subcommittee on investigations, say Medicare Advantage plans are using AI technology and rigged algorithms to deny benefits to members and claims from providers.
If that’s true, and I’m confident it is, that’s some pretty sophisticated shit. Smart robots instantly sifting through millions of health plan benefits packages, individual member benefits, patient medical records and claim forms from providers to make coverage and payment determinations.
Unfortunately, health insurers don’t apply the same level of tech-driven, AI-powered sophistication to do the most basic things like knowing where you live, sending you insurance cards or maintaining accurate provider directories....
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