Is AI Making Claim Denials in Error? What Does It Matter if We Don't Appeal?APTA | By Wanda Evans, PT, DPT, MHS These days, it's hard to escape the attention being paid to artificial intelligence, or AI. The technology is making its way into what seems like every corner of our lives, including in our professional capacities as PTs and PTAs, and in the ways payers make care decisions. Unfortunately, it's not all good news: This year, two behemoth commercial payers, UnitedHealthcare and Cigna, were challenged with potential class-action lawsuits alleging misuse of AI in ways that negatively impacted patient care. In Cigna's case, the allegations are that the insurer relied too heavily on an algorithm that resulted in a high rate of claim denials. UnitedHealthcare is facing a similar allegation that its algorithm denied needed extended care for older adult patients. Of course, media coverage of these suits focuses on the use of AI — and to a large extent, that makes sense. But for health care providers and patients, the real issue here isn't about the use of algorithms, no matter how sophisticated. The real issue is about the importance of appealing denials… |