Lawsuits take aim at use of AI tool by health insurance companies to process claims

The growing use of artificial intelligence by the health insurance industry faces mounting legal challenges, with patients claiming that insurers are using the technology to wrongly deny coverage for essential medical services.

The complaints, which take aim at health insurers United Healthcare and Humana, have sparked fears that AI's integration in the health insurance sector will drive up coverage claims denials, preventing chronically ill and elderly patients from receiving quality medical care. A rash of coverage rejections is fueling calls to increase government oversight of the largely unregulated use of AI by the health insurance industry, experts told CBS MoneyWatch. 

A class-action lawsuit, filed on September 12, alleges that health insurer Humana used an AI model called nHPredict to wrongfully deny medically necessary care for elderly and disabled patients covered under Medicare Advantage — a Medicare-approved plan run by private insurers. Another lawsuit, filed last month, alleges United Healthcare also used nHPredict to reject claims, despite knowing that roughly 90% of the tools denials on coverage were faulty, overriding determinations by patient physicians that the expenses were medically necessary.