It's rather ironic that as I was letting social media play in the background, I was opening the mail and was literally opening a 'refuse to reimburse' letter from my insurance company....
As I read the refusal she was literally discussing the fact that United Healthcare uses AI to determine whether or not your care gets approval or denial. And it was found 90% of the AI determinations were WRONG. When a human looked at them during an appeal process, they were found to be warranted and approved. Yet United CONTINUED TO USE AI - because hello? Almost NO ONE appeals.
As I read the refusal she was literally discussing the fact that United Healthcare uses AI to determine whether or not your care gets approval or denial. And it was found 90% of the AI determinations were WRONG. When a human looked at them during an appeal process, they were found to be warranted and approved. Yet United CONTINUED TO USE AI - because hello? Almost NO ONE appeals.
There’s a major case unfolding right now involving how insurance decisions may be made — including the use of AI.
As a physician, I’m not anti-technology. AI has incredible potential in medicine.
But transparency matters.
And so does clinical judgment.
The most important takeaway for patients:
A denial does not always mean care isn’t needed.
With new 2026 rules requiring insurers to publish denial and appeal rates, we may finally get more visibility into how these decisions are made.
As a physician, I’m not anti-technology. AI has incredible potential in medicine.
But transparency matters.
And so does clinical judgment.
The most important takeaway for patients:
A denial does not always mean care isn’t needed.
With new 2026 rules requiring insurers to publish denial and appeal rates, we may finally get more visibility into how these decisions are made.
