UnitedHealth, Humana, Cigna face lawsuits over AI claim denials
Health insurers are using AI to reject insurance claims despite doctor recommendations, sparking litigation and raising concerns about patient access to care.
What to know
- Three major health insurers—UnitedHealth, Humana, Cigna—face class-action lawsuits alleging they use AI to deny claims and prior authorizations despite doctors' medical necessity determinations.
- Patients report being denied chronic pain medication and having rehabilitation stays cut short by algorithmic decisions, with some described as in tears over denied care.
- Medicare has deployed its own AI tool for prior authorization decisions, expanding algorithmic gatekeeping to federal insurance.
- Researchers argue AI models lack the contextual and social factors necessary for sound clinical decisions, risking harm if algorithms replace human physician review.
“The type of care that clinicians deliver is very sensitive to the patient's unique circumstances. That may not really show up as a number.”
Mika Hamer, Health services researcher, University of Maryland · Vox ↗ · Sep 23
UnitedHealth Group Largest U.S. health insurerHumana Health insurerCigna Health insurerMedicare Federal health programMika Hamer Health services researcher, University of Maryland
How it unfolded 0 developments, newest first · click a bar or a number to jump
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Researcher warns AI models lack nuance for clinical decision-making — Mika Hamer, health services researcher at University of Maryland, argues that clinical care depends on patient circumstances that cannot be reduced to numeric inputs, such as social network completeness and contextual factors unsuitable for algorithmic modeling.
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Doctors report patients denied medication, extended care cut short by algorithms — Doctors report sending complaints to the federal government about patients in distress over denied medication for chronic pain. Legal complaints describe families unable to keep elderly relatives in nursing homes after falls, and patients whose multi-month rehabilitation is terminated after weeks by algorithmic denial.
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UnitedHealth, Humana, Cigna accused of using AI to deny claims — UnitedHealth Group, the largest U.S. health insurer, is facing a class-action lawsuit alleging it uses AI to deny claim payments despite doctors' medical necessity determinations. Humana and Cigna face similar litigation. Medicare has also deployed an AI tool to determine prior authorization approvals.