Industry News

A.I. in Claims Processing

The alleged use of artificial intelligence for prior authorization and claim denials has led to lawsuits against two major health insurance companies. UnitedHealth Group and Cigna have been separately accused of allegedly using automated tools to deny some claims, which plaintiffs say reduces the insurers’ labor costs. Both policymakers and physician leaders are asking insurance companies to open up their AI playbooks in response to these allegations. Both lawsuits are still ongoing.