AI in Health Insurance Coverage Decisions & Disputes

Healthcare insurers are increasingly relying on artificial intelligence (AI) tools to make coverage decisions, approving or denying claims for patient care, sometimes in seconds. A recent survey by the National Association of Insurance Commissioners (NAIC) found that most insurers were using AI to decide whether to authorize coverage—either before treatment (in pre-authorization decisions) or after. While these AI tools offer the possibility of speeding coverage decisions, they can also allow insurers to maximize profits by denying patient claims. Patients, especially those with complex medical needs, may then be forced to pay for their own care, go without care, or attempt to appeal.

Health insurers’ use of AI and machine learning (ML) to make these decisions has caused an uproar. According to NAIC, AI “can present unique risks to consumers, including the potential for inaccuracy, unfair discrimination, data vulnerability, and lack of transparency and explainability.” Consumers are bringing class-action lawsuits and numerous states have taken steps to limit insurers’ use of AI. Meanwhile, new companies are offering AI tools to help patients dispute coverage denials—creating an AI vs. AI insurance battleground.

What are the ethical, legal, and medical implications of this rise in the use of AI for health insurance coverage decisions? What regulations or other safeguards are needed? And what is the future of AI in controlling what health care patients receive? Join three experts to explore this difficult conflict between law, ethics, and medicine.

The webinar is free and open to the public.