A recent investigation by STAT News found that AI algorithms have influenced how Medicare insurers deny insurance to patients.
In some cases, insurers cut off benefits for elderly patients because the AI says they should be better, ignoring what human doctors have to say about the patient’s condition.that as AI continues to become integrated into various industries, its impact on the healthcare sector is starting to become apparent.
As more Americans over 65, and those with disabilities, choose plans with lower premiums and prescription drug coverage, Medicare Advantage has grown significantly more profitable for insurers. These plans, however, give insurers more discretion to limit and refuse services. The last ten years have seen the emergence of a new industry focused on using AI to predict patient discharge dates from hospitals, doctor types, and therapy hours.
The FDA assesses the AI models used by doctors to identify diseases like cancer or recommend the best treatment. In contrast, the tools used by insurers to decide whether to pay for those treatments are not subjected to the same scrutiny, despite their influence on the care of the nation’s sickest patients.
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