AI & Health Insurance Claims: Helpful Future or Hidden Risk?

AI is becoming a key part of how insurance companies handle medical claims, and a recent article offered a clear overview of what’s improving and what remains worrying.

AI systems are now used to verify documents, read medical notes, compare with previous claims, and even decide whether a treatment should be approved. And while this can make the process faster, several concerns are growing:

• Lack of transparency: insurers don’t reveal how their algorithms make decisions.
• High error rates: some AI tools reportedly deny care incorrectly, with many decisions later reversed.
• Risk of bias: chronic patients and vulnerable groups may face more denials.
• Financial incentives: automation can make it easier for insurers to prioritise cost savings over patient care.

Some states in the U.S. have started regulating this, requiring human oversight and more patient-centred criteria. There are also new AI tools helping patients draft appeal letters, an interesting twist.

Overall, AI will play a bigger role in insurance claims. Whether it becomes helpful or dystopian depends entirely on how it’s governed.

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