AI is denying your healthcare (and it's getting worse)
Vanessa Wingårdh
@vanessawingardhAbout
Developer exploring the dark side of tech
Video Description
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. 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 To support the channel: https://patreon.com/VanessaWingardh 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
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