Using AI to Deny Health Care

A federal judge recently ruled that Humana must face a class-action lawsuit for its use of artificial intelligence.

In addition to being blatantly unethical, Humana has proven itself to be so embarrassingly lazy and cheap that they are using robots to deny care to its patients instead of people. Perhaps this is also because humans tend to have morals and empathy, and Humana’s corporate cannot risk this interfering with their profit.

However, it was presumed by the judge that AI was used by the company as an excuse to not use the informed judgment of real human clinicians. Whether this is better or worse than the other explanations is up to the reader. Yet one thing is clear: when all else fails, the law can still hold health insurance giants accountable for their actions.

New survey shows the dangers of for-profit health care. McKnight’s reported that according to the American Health Care Association, two-thirds of nursing homes say they see Medicare Advantage plans delaying or denying care that’s determined to be medically necessary. 29% of surveyed facilities report seeing such delays/denials every day, with another 37% reporting the situation to be a weekly occurrence. Another 17% state the challenge is seen to take place at least every month. That’s almost all nursing homes consistently witnessing the denial of care.

It’s likely unsurprising to find that many insurance plans delay or even deny necessary care to nursing home residents, but what may surprise you is the extent to which it is done. Worse, over two-thirds of nursing facilities reported to have experience with an MA plan that removed a resident’s coverage “against medical advice.”

But the horror doesn’t stop there. In 2024, a Senate investigation concluded that some plans consciously and intentionally deny coverage to their patients simply because they assume the patients will never appeal the rejection. Apparently paying for insurance is not enough; customers must also go to extensive and complicated lengths to receive proper medical care during their time of need.

As Clif Porter, president and CEO of AHCA explained, “This constant hoop jumping is resulting in too many skilled nursing patients being discharged too soon against medical advice, threatening their recovery.”

That being said, it is critical that Americans continue to advocate for the health care they need, regardless of how many tedious phone calls, appeals, or lengthy documents are required. This is a fight between life-saving care and corporate profit, and victims of this corporate greed must do everything in their power to ensure they get the care they deserve. Fortunately, those fighting for the care they need are far from alone and may also look to seasoned attorneys who are more than familiar with the everyday struggles against healthcare. Attorneys can advocate for their clients far more effectively than most victims are ever able to, as the law is one thing corporate greed cannot skirt around.