Denial—Artificial Intelligence Tools and Health Insurance Coverage Decisions

Michelle M. Mello

(Originally published by JAMA Health Forum on March 7, 2024)

Utilization review by health insurers is the type of problem that seems, on the surface, to cry out for solutions using artificial intelligence (AI). The staggering volume and complexity,1 inefficiency, and decision-making that requires sophisticated evaluation (yet feels like administrative drudgery for insurance plan staff) make insurance reviews an attractive target for using AI. The market has responded robustly; however, the results illustrate that seemingly perfect opportunities for using AI can become clear examples of how algorithms can go awry when humans do not provide the expected bulwark against error.

(Continue reading the opinion essay on JAMA Health Forum’s page here)