New AI tool counters health insurance denials decided by automated algorithms Class-action lawsuits allege algorithms turn down claims in seconds and critics say reform is needed for lasting change.
The lawsuit against them alleged that nH Predict has a 90% error rate, meaning nine out of 10 denials are reversed upon appeal – but that vanishingly few patients (about 0.2%) appeal their denied claims, leading them to pay bills out of pocket or forgo necessary treatment.
Insurance coverage denials have risen in recent years in the US, driven in part by automated algorithms powered by AI – and some recently launched artificial intelligence tools may fight back by generating automatic appeals.
In 2020, UnitedHealth Group acquired naviHealth and its algorithm for predicting care, called nH Predict, which UnitedHealth uses and also contracts out to other insurers, including Humana.
But to see more lasting change, health experts say that the health insurance system needs greater reform to control high prices and ensure coverage.
