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Humana also using AI tool with 90% error rate to deny care, lawsuit claims (arstechnica.com)

submitted 9 months ago by [email protected] to c/[email protected]

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Humana also using AI tool with 90% error rate to deny care, lawsuit claims::The AI model, nH Predict, is the focus of another lawsuit against UnitedHealth.

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[–] [email protected] 4 points 9 months ago (2 children)

Is there proof of this? My mom works for Humana doing LTC and neither she or the medical directors she forwards cases to use this tool?

[–] Cheers 7 points 9 months ago

It's probably on claim submission.

My company operates as an LTC pharmacy. We pay for every claim submission whether reject or success.

I was on the phone the other day with my pharmacy (optum) and they did a "test" claim which was free for them. I know optum owns the pharmacy, insurance, and pbm, but either their abusive their vertical integration or they have an "ai" to test claims.

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