On February 6th, the US government issued a memo to Medicare insurers, clarifying that AI cannot be used as the sole basis for denying claims. The memo was issued in response to lawsuits against health insurers such as United Healthcare and Humana who have been accused of using AI to wrongly deny coverage. Patients claim that the AI model nHPredict has a 90% error rate, highlighting a dangerous aspect of the technology that is receiving increased attention.
While machine-learning algorithms can assist in making determinations, they cannot make decisions on their own. This memo serves as a reminder that insurers must ensure their models comply with anti-discrimination requirements and verify the fairness of their algorithms. Several states, including New York and California, have also warned insurance companies to take this issue seriously and not rely solely on AI when making decisions about coverage.
As someone who recently suffered an injury and required medical attention, I can attest to how frustrating it is when an insurance claim is denied without proper explanation or justification. It’s important for patients to understand their rights and advocate for themselves when faced with discrimination or bias in the healthcare system.