AI Tools Target Rising Health Insurance Denials

Recent reports indicate a rise in insurance claim denials in the U.S., driven by the increasing use of artificial intelligence algorithms that evaluate and often reject claims. Class-action lawsuits against major insurers such as UnitedHealth, Humana, and Cigna allege that these algorithms collectively contribute to a significant number of unjust denials, with one lawsuit claiming a 90% error rate in denial decisions that are later reversed upon appeal. Health experts argue that while automated tools for generating appeals may provide some relief, systemic reform is crucial to address the high costs and coverage issues within the health insurance sector. Consumer rights advocates have highlighted unethical practices such as arbitrary claim rejections and the manipulation of policy terms, which further complicate the claims process for policyholders. Individual stories, like that of a patient denied essential treatment, illustrate the frustrating and often perilous consequences of such insurance practices. As the use of AI continues to grow in the industry, calls for regulatory oversight and better governance structures are becoming increasingly urgent to protect consumer rights and ensure fair treatment.