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

submitted 10 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 10 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?

[–] [email protected] 7 points 10 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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