AI is doing the dirty work for insurance companies, and it’s getting worse
AI is now deciding whether your insurance claim gets approved, and denial rates are climbing fast. Here's what's happening and why your doctor's opinion might not matter anymore.
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AI is getting really good at saying no to your insurance claims, and the numbers are distressing.
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Insurance claims adjusters have never had a reputation for generosity. But at least they were human. That’s changing fast, and not in your favor. A report by Futurism details how AI automation is now a major trend in personal insurance, the health, home, and auto coverage most of us rely on.
Is your doctor’s opinion even part of the process anymore?
It doesn’t seem that your doctor’s opinion carries that much weight now. A Palm Beach Post investigation found that Iris Smith, an 80-year-old suffering from arthritis, may be a victim of AI-fueled preauthorization denials.
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In another case, UnitedHealth is currently facing a class-action lawsuit alleging that AI-denied Medicare nursing care contributed to patient deaths. Meanwhile, a National Association of Insurance Commissioners survey found 84% of health insurers are using AI, with 68% deploying it for prior authorization approvals.
Most people give up and don’t even appeal these rejections because the process is too confusing or exhausting, which, if you’re an insurance company, is the outcome you want.
The worst part is that we know AI isn’t always accurate and has a tendency to hallucinate. It’s one thing if it makes a mistake while writing a report, but it’s a completely different ball game when it ends up denying medical aid to someone who truly needs it.
Is there anyone protecting your interests?
Florida Representative Lois Frankel isn’t having any of it. She told the Palm Beach Post she plans to fight any expansion into other states. “We believe Medicare was based on a promise that if your doctor says you need care, if you’re hurt and you need care, Medicare will be there for you, not AI.”
But if the past is any indication, her fight alone won’t be enough. Florida lawmakers tried to pass a bill in 2025, requiring human review for AI-generated denials. It passed the House, died in the Senate, and a Trump executive order discouraging state AI regulations didn’t help.
The silver lining, if you can call it that: nonprofits like Counterforce Health now offer free AI tools that analyze your denial letter and draft a customized appeal, making it easier to fight back. It’s AI versus AI at this point, and the world is growing gloomier by the day.
Rachit is a seasoned tech journalist with over seven years of experience covering the consumer technology landscape.
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