Corporate health insurers use NaviHealth algorithms to deny care in Medicare Advantage plans

Beware of corporate health insurers that use NaviHealth, an AI system tha can inappropriately deny care to people in Medicare Advantage plans. Former employees at NaviHealth report that its AI algorithms wrongly deny care to Medicare Advantage enrollees in serious health, reports Stat News. UnitedHealth, which owns NaviHealth, and other health insurance companies, rely on NaviHealth in their medical decisionmaking,

Employees at NaviHealth are complaining in internal communications that insurers are denying care to people who are on IVs in rehab facilities. Medicare should cover up to 100 days in a rehab facility for eligible individuals. But, NaviHealth sometimes determines that they need to leave rehab before it is appropriate for them to do so.

As Stat previously reported, insurance corporations use AI–computer programs–to deny care to Medicare Advantage enrollees with serious diseases and injuries. The NaviHealth system does not consider individual patient’s needs in its determinations about when to stop covering care. Patients, physicians and NaviHealth workers are “increasingly distressed” that patients are not able to get the care they need as a result of these computer algorithms.

Former medical review employees at NaviHealth say that they were not allowed to use their independent clinical judgment to allow continued stays in rehab facilities when the NaviHealth system said to deny care; they had to follow the algorithms. “That was very different from before we were owned by Optum.”