Legal Challenges Arise Over Health Insurance Companies' Use of AI for Claims Processing

The use of artificial intelligence in the health insurance sector is facing legal opposition, as patients allege that insurers are employing AI technology to unjustly reject coverage for crucial medical treatments. Lawsuits have been filed against United Healthcare and Humana, raising concerns over the potential increase in coverage denials, which could hinder access to quality healthcare for chronically ill and elderly individuals. The lack of regulation surrounding AI use in health insurance has prompted calls for increased government oversight. One class-action suit accuses Humana of utilizing an AI model, nHPredict, to wrongfully deny necessary care for elderly and disabled patients covered under Medicare Advantage, while another lawsuit alleges that United Healthcare also used nHPredict to reject claims, despite the tool's high rate of faulty denials. Both insurers are accused of enforcing policies that prioritize nHPredict's algorithmic decision-making over medical necessity, with employees facing repercussions for deviating from the model's projections. The rise in claim rejections, potentially linked to the adoption of AI tools, has sparked concerns about the impact on Medicare patients. Legal battles against United Healthcare and Humana could influence future regulations regarding AI technology in the health insurance industry.