Submission + - AI Arms Race Emerging Between Patients and Health Insurers
An anonymous reader writes: PBS NewsHour has a segment on the escalating AI battle in health insurance claims. A 2025 survey found 71% of health insurers admit to using AI for utilization management—the process that approves or denies claims. Of the 73 million Americans on ACA plans who had in-network claims denied, and less than 1% appealed. Now patients are fighting back with AI of their own. Free, open-source tools like Fight Health Insurance and the free Counterforce Health let patients upload denial letters and generate customized appeals citing relevant regulations and medical necessity arguments. Indiana University law professor Jennifer Oliva warns this is becoming an arms race: "As consumers become more empowered by these tools to fight back, the insurers will just up the ante." She also raises a darker concern—insurers may be using AI to identify patients unlikely to appeal or who "will not live through an appeal based on the time that the appeals take." Current regulation is nearly nonexistent.
