Artificial intelligence is increasingly used by insurance companies to make decisions on claims for home repairs and medical procedures.
Florida is one of 22 states without specific rules or guidance addressing the use of AI in the insurance industry.
A failed Florida bill would have required a human to review any insurance claim denial that was initially generated by AI.
A new pilot program is testing the use of AI for prior authorization in traditional Medicare, which has historically had fewer restrictions than commercial plans.
You have a leaky roof, or your doctor has recommended a knee replacement to alleviate your pain. These scenarios are why you have insurance, but now the decision likely involves a machine’s determinations.
Using artificial intelligence to do your taxes, answer your questions and eliminate all varieties of tedium from your life has its appeal. However, the benefits to consumers might seem more uncertain when it’s AI that is deciding what insurance will pay for your home repairs or whether your surgery will get covered.
Florida, a disaster-prone state where residents typically pay among the highest property insurance premiums in the country, is among the 22 states that have not adopted rules or guidance that specifically address AI.
At this stage, AI’s role in insurance is already spawning lawsuits and battles over its regulation, as well as a lot of anxiety about its role in the future. A class-action lawsuit against UnitedHealth Group, the nation’s largest insurer, is being closely watched. It alleges that an algorithm was used to deny nursing home care to its Medicare Advantage beneficiaries, resulting in their deaths.
Iris Smith, 80, has worked for doctors’ offices, hospitals and managed care companies, and a big reason the Delray Beach resident says she opted for the more expensive traditional Medicare plan is because the coverage doesn’t involve asking for permission, also known as preauthorization, as most commercial and Medicare Advantage plans do for a wide array of services.
Involving AI in preauthorization, as a current six-state pilot program is testing for traditional Medicare enrollees, is particularly horrifying to her.
“I don’t think a corporation … should be telling people what they can and can’t do,” said the retiree, who suffers from arthritis.
AI is denying health care claims
