Providers ‘potentially wasted’ almost $18B in 2023 overturning claims denials, Premier estimates (Fierce Healthcare)

In 2023, healthcare providers in the United States potentially expended nearly $18 billion overturning denied insurance claims, according to estimates by Premier. This significant financial burden is partly attributed to the increasing use of artificial intelligence (AI) by insurance companies to automate claim denials. While AI can streamline operations, its application has led to a rise in claim denials, often without thorough human review, prompting legal challenges and legislative actions. For instance, California enacted a law in December 2024 mandating that any denial, delay, or modification of care based on medical necessity must be reviewed by a licensed physician or qualified healthcare provider, aiming to curb the misuse of AI in utilization reviews.