States try to rein in health insurers’ claim denials, with mixed results

A prescription is filled in Morganton, N.C. North Carolina is among the states considering legislation designed to regulate health insurers’ prior authorization and claims reviews. (Chris Carlson/The Associated Press)

Health insurance companies are under increasing scrutiny for allegedly using artificial intelligence bots and algorithms to swiftly deny patients routine or lifesaving care — without a human actually reviewing their claims.

The high-profile killing late last year of UnitedHealthcare CEO Brian Thompson has focused even more attention on so-called prior authorization, the process by which patients and doctors must ask health insurers to approve medical procedures or drugs before proceeding. There had been protests and outrage over the company’s practices for months before Thompson’s death, and UnitedHealthcare has been accused in a class-action lawsuit of using AI to wrongfully deny claims…

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