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As insurers increasingly lean on artificial intelligence to speed claims processing and prior authorizations, a parallel AI industry is emerging to fight back, Louisiana Illuminator reports.
Startups and nonprofits such as Sheer Health and North Carolina–based Counterforce Health are rolling out consumer tools that scan policies, decode jargon, flag coding errors and even draft appeal letters for denied surgeries and sky-high bills.
Early adopters include younger adults who already use chatbots for health advice, even as most Americans say they don’t fully trust the results. Denials are rising—insurers on ACA marketplaces rejected nearly one in five in-network claims last year—and lawmakers in more than a dozen states are moving to ban AI-only decisions and demand human oversight and bias checks.
Regulators, clinicians and legal experts say AI can streamline an opaque system, but warn that without clear guardrails, patients could be left on an “AI treadmill” where two algorithms quietly decide who gets care.
