A while back, I reported on a story in Stat News that exposed a division of UnitedHealth, NaviHealth that uses artificial intelligence, AI, to deny thousands of Medicare Advantage claims, in seconds. Now, Stat News reports that UnitedHealth is renaming NaviHealth, with all the evidence pointing towards UnitedHealth continuing to deny claims en masse with the help of the renamed company. If you need a reason not to enroll in a Medicare Advantage plan or to disenroll from one, NaviHealth or whatever it’s new name, is as good as any.
The original Stat News story explained that UnitedHealth, as well as many other health insurance companies, rely on NaviHealth, an AI system, in its medical decisionmaking to 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.
Employees at NaviHealth complained in internal communications that insurers were denying care to people who are on IVs in rehab facilities. Medicare should cover up to 100 days in a rehab facility or nursing home for eligible individuals. But, NaviHealth sometimes determines that people need to leave rehab before their treating physicians believe that it is appropriate for them to do so. In 2022, the Office of the Inspector General of the Department of Health and Human Services reported widespread and persistent delays and denials of care in some Medicare Advantage plans, including denials of rehab and skilled nursing services.
As Stat previously reported, insurance corporations use AI–computer programs–to deny care to Medicare Advantage enrollees with serious diseases and injuries, when traditional Medicare would have covered the care. The NaviHealth system wrongly 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.
Here’s more from Just Care:
- OIG finds widespread inappropriate care denials in Medicare Advantage
- Insurers will continue misleading people, notwithstanding new Medicare Advantage marketing rules
- 2023: Five things to think about when choosing between traditional Medicare and a Medicare Advantage plan
- Well-kept secrets of Medicare Advantage plans
- Medicare Advantage plans denied two million prior authorization requests in 2021
