Name: Health insurers AI systems causing explosion of denials
Uploaded: 2024-12-10T00:09:12.141Z
Duration: 5 min 5 s
Description: Dr. Ashish Jha, Brown University School Of Public Health dean, warns that AI is causing a surge in insurance claim denials, with some data suggesting that 25 to 30 per cent of claims are being inappropriately denied.

Dr. Ashish Jha, Brown University School Of Public Health dean, warns that AI is causing a surge in insurance claim denials, with some data suggesting that 25 to 30 per cent of claims are being inappropriately denied.

New York

The release of Open AI's ChatGPT has accelerated the development of artificial intelligence and warnings about its impact on society.

Rise of AI

Health insurers' increased reliance on artificial intelligence is raising concerns about a significant rise in insurance claim denials. Dr. Ashish Jha, Dean of Brown University's School of Public Health, has highlighted the issue, stating that technology is contributing to a surge in denials, with some estimates suggesting that 25 to 30 percent of claims are inappropriately denied.

Although comprehensive data is not yet available, anecdotal evidence from doctors, patients, and health systems suggests that the use of AI in processing claims may lead to increased frustration within the healthcare system. Dr. Jha emphasizes the importance of transparency from insurance companies, encouraging the disclosure of denial rates and the models used.

Dr. Jha argues that AI's reliance on historical data may perpetuate biases and inappropriate denials, indicating a need for careful development and deployment of models. Transparency and data reporting would promote better model development and improved denial processes, fostering a more efficient and fair insurance industry. 



Health insurers' AI systems causing 'explosion of denials'

Authorities have not given a motive yet, but the murder comes as insurance companies rely more and more on technology, specifically artificial intelligence, to process claims. Brown University's School of Public Health dean warns the technology is causing a surge in denials. Dr. Ashish Jha joins us now. Dr. Jha, thank you for being with us. We do appreciate it. We talk about, typically on this show, AI as being great for corporate America. It saves a lot of money. It cuts down on costs, et cetera. For the insurance industry, what have we seen so far, because it is still early days, in terms of the impact? Yes. So, first of all, thanks for having me here. It is early days, and insurance companies have jumped right into this, and they're using this technology to do a lot more denials, a lot of inappropriate denials. Some data suggests that 25 to 30 percent of claims may be getting denied using AI technology. So it's a real challenge. How do we actually know that it's causing an increase in denials? Because those numbers aren't readily available. And as I understand it, part of the Affordable Care Act allows federal regulators to collect that information. But in large part, that information hasn't been collected. So how do we know that this is actually causing a spike in denials? It's a great question. I mean, certainly, anecdotally, we hear this from doctors who describe this, and from patients as well. And it's really caused a lot more frustration. We heard it from health systems. I think it's important that companies actually report this data. What proportion of claims are they denying? What claims are they denying? Transparency is going to be very, very important here. The important thing to understand also about the use of AI, and we know this from the use in other industries, is that it's only as good as the data you put in. And so for the insurance industry, what sort of data is being put in there? Because you think about AI models, and the potential is that in the past, they denied certain amounts of claim. And so this sort of perpetuates those denials, as well as perhaps even biases when it comes to race and gender. Yeah, exactly. And so, look, in the past, when you denied claims based on, let's say, a really expensive drug for which there was a cheaper alternative or expensive treatment, that made sense, or at least it was reasonable to do. The way these models are getting built and the way they're being deployed, we just actually know very little about it. What we're seeing is a lot more denials, including denials of things that are obviously necessary services. And so that is, I think, what is causing so much friction in the system and so much frustration for doctors and patients. Do you think AI is, and I hate to ask this question because it is so early in sort of the AI impact on any industry at this point, but AI uses historical data. Do you think that it's agile enough, so to speak, in the medical industry to actually say, you know what, we can approve this medicine because it is actually better and it's new? Yeah, it's a great question. My view is over time, these models will get better as long as we're focused on trying to make them better. AI definitely can be used to make sure that care is more appropriate, that unnecessary stuff isn't being done. It's just not how insurance companies are using it right now. Right now, they're using it to try to deny a lot more things with the hope that they're going to be able to spend less money on health care. It's causing a lot of side effects, as it were. Over time, I hope these models get better. Do you think that this is going to be the moment that we look back on, you know, this moment in time here with the tragic killing of the CEO, when we actually took this moment to try and address some of the issues in the health care industry? Yeah, well, first and foremost, I mean, this murder was completely horrible, unjustified. And I hope that we see this nothing but as an unadulterated evil. Now, that said, it has sparked a national conversation. I think insurance companies have to do a better job of focusing on these issues. And to the extent that it might lead to some policy action, that would be a good thing. Again, the murder itself is terrible. But I am hoping that maybe we can see some more reforms in this industry. You have worked in the government during the COVID pandemic. And so I'm wondering, you know, if you were to advise lawmakers, advise whatever agencies, HHS, as to what to look into in the insurance industry from your perch at the School of Public Health, what would that be, first and foremost, from the consumer standpoint? I mean, first and foremost, I think we need a lot more transparency. You know, the fact that we don't know what proportion of claims are being denied is a huge problem. I think companies should be very transparent about what are they denying, why are they denying it. If you're using AI, what models are you using? I think all of that would be extremely helpful. It would create incentives to build better models, and it would create incentives for people to be much more appropriate in how they do denials. That's all stuff that government regulators and government agencies can demand. And I think that would make an important difference. Thank you. Thank you. Thank you.

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Rise of AI