this post was submitted on 14 Dec 2023
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Humana also using AI tool with 90% error rate to deny care, lawsuit claims (arstechnica.com)
submitted 1 year ago by L4s to c/technology
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Humana also using AI tool with 90% error rate to deny care, lawsuit claims::The AI model, nH Predict, is the focus of another lawsuit against UnitedHealth.

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[–] [email protected] 7 points 1 year ago

It's probably on claim submission.

My company operates as an LTC pharmacy. We pay for every claim submission whether reject or success.

I was on the phone the other day with my pharmacy (optum) and they did a "test" claim which was free for them. I know optum owns the pharmacy, insurance, and pbm, but either their abusive their vertical integration or they have an "ai" to test claims.