As health insurers increasingly rely on artificial intelligence to process claims,

denials have been on the rise.

In recent years, nearly 20% of claims filed by Americans on Affordable Care Act plans were denied.

In 2023 alone, that number added up to about 73 million people who had filed claims for in-network services.

Less than 1% of them tried to appeal their claim,

either because the process was too lengthy or too confusing.

Now artificial intelligence is being used to help patients fight back.

Software companies are harnessing the power of AI

to create detailed appeal letters for patients

in a fraction of the time it would take a human to do.

Joining us to talk about the AI battle in health insurance is Jennifer Oliva,

professor at Indiana University's Mauer School of Law.

Thank you so much for joining us.

So before we talk about some of these new ways companies are using

AI to fight back against claim denials, I want to talk about how health insurance companies

have up until this point been using AI and other automated predictive algorithms to work

into their claim approval or denial systems.

Yeah, it's somewhat of a mystery, to be fair, because there's no way to know for sure,

but the National Association of Insurance Commissioners sent out a survey to health insurers in

2025, and they answered 71% of them said we're using AI for utilization management,

which means that they're admitting in a survey where they can say whatever they want,

that they are using it for prior and concurrent authorization processes.

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