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AI is now denying your healthcare (and it's getting worse)
AI is being used to determine your healthcare coverage, to set the price of your premium, and to dictate the level of care you receive… if any.
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Sources:
ProPublica https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims
ProPublica https://www.propublica.org/article/evicore-health-insurance-denials-cigna-unitedhealthcare-aetna-prior-authorizations
Complete source documentation is available on Patreon
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Chapters:
00:00 Intro
00:40 Using AI Agents in Insurance Underwriting
01:58 AI Setting Policy, Price, and Coverage
02:25 Court Case: Gene Lokken
02:55 ProPublica: Chris McNaughton
04:02 Prior Authorization Required Before Treatment
04:48 AI Models Process Requests
06:18 Doctor Peer-to-peer Reviews
07:37 EviCore and NaviHealth AI Claims
08:06 Insurance Purchased EviCore and NaviHealth
09:07 nH Predict AI Model
09:49 American Medical Association
10:01 Can A Doctor Override the AI?
10:31 Cigna’s EviCore AI
11:07 EviCore “Sentinel Effect”
11:34 Medicare versus Medicare Advantage
12:21 Medicare Will Now Have AI Prior Authorization
13:55 Can AI Legally Deny Claims?
14:44 Appeal Your Denials
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