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NAIC data shows most insurers use AI, including for prior authorizations
NAIC survey data found 84% of health insurers use AI or machine learning, and 12% apply it to deny prior authorizations, while nearly a third do not regularly test for bias.
A public AI spat between Mark Cuban and Marc Andreessen has refocused attention on how health insurers are using AI in the claims process, including tools that can affect coverage decisions after a patient receives a diagnosis, Insurance Business reports.
The NAIC's most recent Artificial Intelligence and Machine Learning survey, based on responses from 93 health insurers across 16 states, found that 84% use AI or machine learning in some capacity, and 12% specifically use it to deny prior authorizations.
The same NAIC survey found nearly a third of health insurers do not regularly test their models for bias or discrimination, despite NAIC guidance recommending such testing since December 2023.
The reporting also cites KFF analysis of Affordable Care Act marketplace data, which found fewer than 1% of denied ACA claims were appealed in 2023, with insurers upholding 56% of denials that were challenged, and notes that California's Physicians Make Decisions Act, effective January 2025, bars insurers from denying medically necessary care based solely on an algorithm and requires licensed human review.