AI is now denying your healthcare (and it's getting worse)

10 days ago
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AI is being used to determine your healthcare coverage, to set the price of your premium, and to dictate the level of care you receive… if any.
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Sources:
ProPublica https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims
ProPublica https://www.propublica.org/article/evicore-health-insurance-denials-cigna-unitedhealthcare-aetna-prior-authorizations
Complete source documentation is available on Patreon
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Chapters:
00:00 Intro
00:40 Using AI Agents in Insurance Underwriting
01:58 AI Setting Policy, Price, and Coverage
02:25 Court Case: Gene Lokken
02:55 ProPublica: Chris McNaughton
04:02 Prior Authorization Required Before Treatment
04:48 AI Models Process Requests
06:18 Doctor Peer-to-peer Reviews
07:37 EviCore and NaviHealth AI Claims
08:06 Insurance Purchased EviCore and NaviHealth
09:07 nH Predict AI Model
09:49 American Medical Association
10:01 Can A Doctor Override the AI?
10:31 Cigna’s EviCore AI
11:07 EviCore “Sentinel Effect”
11:34 Medicare versus Medicare Advantage
12:21 Medicare Will Now Have AI Prior Authorization
13:55 Can AI Legally Deny Claims?
14:44 Appeal Your Denials

Source: https://www.youtube.com/watch?v=VglEngqloIg

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