Provider and Patient-Focused AI Pushes Back Against Insurance Companies
Whether you’re a patient in need of healthcare services and insurance compensation, or you work in a healthcare setting, you’ve already learned that both auto insurance and health insurance companies in the United States are relying more and more on artificial intelligence (AI) and cost-saving computer programs in order to limit or deny insurance payments for healthcare services. If an insurance company receives a claim for payment that does not meet its reimbursement guidelines, it will deny payment, leaving patients without insurance compensation, stuck paying out of pocket for costly but necessary healthcare services.
Both patients and providers can engage in a complex appeals process when insurance claims are partially paid or denied outright, but the time and cost for doing so understandably adds an extra layer of frustration, confusion, time and expense – all with an uncertain outcome.
Fortunately for patients and healthcare providers, the power of artificial intelligence is now being leveraged in favor of healthcare providers and patients when insurance claims meet resistance. Waystar, a healthcare payment corporation that seeks to modernize healthcare payment systems to catch up with rapidly evolving clinical practices and technologies, recently announced the launch of its new “Altitude AI”.[1] This generative AI[2] is now being used by hospitals to combat insurance payment denials, and it could soon be available to other healthcare providers. This modernization will help patients receive insurance compensation from claims such as a collision claim, car insurance claim, or personal injury claim.
With hospitals and other healthcare systems spending a reported $20 billion per year[3] just to push back against denied insurance claims, Altitude AI helps users by automatically creating detailed appeals letters when claims are denied, saving both hospitals, their staff, and patients time, stress, and dollars in the process – at least those are the intended goals. Doing so can keep healthcare providers performing their highest and best uses – caring for patients, while triaging and challenging denials in a paperless format.
Waystar’s list of features and benefits for its AI includes[4]:
- Reporting on root causes to help prevent medical billing denials
- AI + predictive analytics to prioritize the denials most likely to be overturned and paid
- Automated appeal generation and submission[5]
However, with an estimated 450 million health insurance related claims denied annually, intelligent software such as Altitude AI can start to level the playing field for providers, their employees, and their patients. Those of us in the legal profession who advocate on behalf of injured patients are encouraged by these developments. We see firsthand how the betrayals by a client’s own insurance company can negatively affect that client’s ability to focus on the healing process after an injury.
While Washington State has powerful laws in place to protect insureds from being victimized by their insurance companies, not all of these laws apply to healthcare insurers, leaving room for emerging technologies such as AI to help with denials of insurance benefits. One important consideration to keep an eye on will be whether the cost of such technologies outweighs the expected benefits. Waystar believes so, as it reports that 63% of insurance denials are recoverable in some form.
We will continue to monitor and report on developments in this rapidly evolving field.
Do you have questions about the ins and outs of auto insurance and insurance compensation? Take a look at this past article that answers commonly asked questions about collision insurance, car insurance, PIP coverage, and more. Also, be sure to grab a copy of one of our free books that can further illuminate important insurance, legal, and medical topics.
[1] Healthcare Revenue Cycle Management Solutions | Waystar
[2] According to IBM, Generative AI, sometimes called gen AI, is artificial intelligence (AI) that can create original content—such as text, images, video, audio or software code—in response to a user’s prompt or request.
[3] Health AI: New tool will help fight health insurance denials
[4] Claim Denial Prevention + Recovery | Fixing Medical Billing Denials
[5] Legal disclaimer time: we do not represent nor endorse Waystar.
