The Battle Over Healthcare: How AI is Changing the Game
A new technology, AI-powered bots, has emerged as a way to fight insurance companies that deny care to patients. The healthcare industry has become increasingly reliant on AI tools to process claims and make decisions about patient care.
This shift in power dynamics has sparked concerns among lawmakers and medical professionals who argue that AI is being used to replace human decision-making with algorithms. "We don't want to get on an AI-enabled treadmill that just speeds up," said Carmel Shachar, assistant clinical professor of law at Harvard Law School.
One company, Sheer Health, has created an app that allows patients to connect their health insurance account, upload medical bills and claims, and ask questions about deductibles, copays and covered benefits. The program uses both AI and humans to provide the answers for free. However, patients who want extra support in challenging a denied claim or dealing with out-of-network reimbursements can pay Sheer Health to handle those for them.
In North Carolina, a nonprofit organization called Counterforce Health designed an AI assistant to help patients appeal their denied health insurance claims and fight large medical bills. The free service uses AI models to analyze a patient's denial letter, then look through the patient's policy and outside medical research to draft a customized appeal letter.
While some experts see AI as a game-changer for healthcare, others are warning about its limitations. "AI can be difficult for a layperson to understand when it is doing good work and when it is hallucinating or giving something that isn't quite accurate," said Shachar.
The trend of using AI-powered chatbots for health information has also raised concerns. According to a poll by the health care research nonprofit KFF, 25% of adults under age 30 use an AI chatbot at least once a month for health information or advice. However, most adults are not confident that the health information is accurate.
State legislators on both sides of the aisle have stepped up oversight, with several states banning insurance companies from using AI as the sole decisionmaker in prior authorization or medical necessity denials.
Lawmakers like Dr. Arvind Venkat, a Democratic Pennsylvania state representative and an emergency room physician, are pushing for regulations that would force insurers and healthcare providers to be more transparent about how they use AI and require human oversight.
"The conclusions from artificial intelligence can reinforce discriminatory patterns and violate privacy in ways that we have already legislated against," said Venkat. "We need to make sure we're applying artificial intelligence in a way that looks at the individual patient."
The increasing reliance on AI in healthcare has sparked a debate about the role of technology in decision-making. While some experts see AI as a valuable tool, others argue that it should be used in conjunction with human judgment.
"It's not an answer," said Mathew Evins, who worked with his physician to appeal a denied claim using an AI chatbot before turning to Sheer Health for assistance. "AI, when used by a professional that understands the issues and ramifications of a particular problem, that's a different story."
The use of AI in healthcare has sparked concerns about bias and accuracy. Research has shown that AI can reinforce discriminatory patterns, and lawmakers are taking steps to address these concerns.
Ultimately, the future of healthcare will depend on finding the right balance between technology and human decision-making. As one expert said, "There's a huge opportunity for AI to improve the patient experience and overall provider experience. But we need to be careful not to replace human interaction with machines."
A new technology, AI-powered bots, has emerged as a way to fight insurance companies that deny care to patients. The healthcare industry has become increasingly reliant on AI tools to process claims and make decisions about patient care.
This shift in power dynamics has sparked concerns among lawmakers and medical professionals who argue that AI is being used to replace human decision-making with algorithms. "We don't want to get on an AI-enabled treadmill that just speeds up," said Carmel Shachar, assistant clinical professor of law at Harvard Law School.
One company, Sheer Health, has created an app that allows patients to connect their health insurance account, upload medical bills and claims, and ask questions about deductibles, copays and covered benefits. The program uses both AI and humans to provide the answers for free. However, patients who want extra support in challenging a denied claim or dealing with out-of-network reimbursements can pay Sheer Health to handle those for them.
In North Carolina, a nonprofit organization called Counterforce Health designed an AI assistant to help patients appeal their denied health insurance claims and fight large medical bills. The free service uses AI models to analyze a patient's denial letter, then look through the patient's policy and outside medical research to draft a customized appeal letter.
While some experts see AI as a game-changer for healthcare, others are warning about its limitations. "AI can be difficult for a layperson to understand when it is doing good work and when it is hallucinating or giving something that isn't quite accurate," said Shachar.
The trend of using AI-powered chatbots for health information has also raised concerns. According to a poll by the health care research nonprofit KFF, 25% of adults under age 30 use an AI chatbot at least once a month for health information or advice. However, most adults are not confident that the health information is accurate.
State legislators on both sides of the aisle have stepped up oversight, with several states banning insurance companies from using AI as the sole decisionmaker in prior authorization or medical necessity denials.
Lawmakers like Dr. Arvind Venkat, a Democratic Pennsylvania state representative and an emergency room physician, are pushing for regulations that would force insurers and healthcare providers to be more transparent about how they use AI and require human oversight.
"The conclusions from artificial intelligence can reinforce discriminatory patterns and violate privacy in ways that we have already legislated against," said Venkat. "We need to make sure we're applying artificial intelligence in a way that looks at the individual patient."
The increasing reliance on AI in healthcare has sparked a debate about the role of technology in decision-making. While some experts see AI as a valuable tool, others argue that it should be used in conjunction with human judgment.
"It's not an answer," said Mathew Evins, who worked with his physician to appeal a denied claim using an AI chatbot before turning to Sheer Health for assistance. "AI, when used by a professional that understands the issues and ramifications of a particular problem, that's a different story."
The use of AI in healthcare has sparked concerns about bias and accuracy. Research has shown that AI can reinforce discriminatory patterns, and lawmakers are taking steps to address these concerns.
Ultimately, the future of healthcare will depend on finding the right balance between technology and human decision-making. As one expert said, "There's a huge opportunity for AI to improve the patient experience and overall provider experience. But we need to be careful not to replace human interaction with machines."
I'm worried about where this is all headed. I mean, AI is cool and all, but when it starts making decisions on our lives, especially something as important as healthcare, that's a whole different ball game. I've seen some of these AI chatbots in action, and they can be really helpful, but what happens when we're not tech-savvy folks trying to navigate complex medical issues? We need human touch, you know? My sister went through this with her insurance company, and she got lost in all the paperwork. She ended up paying out of pocket because she couldn't figure it out herself. It's like, shouldn't our healthcare system be designed to support people, not just spew out algorithms? 
. It sounds like it could make things easier for patients, but at what cost? We don't want robots making decisions that affect our health without us even knowing what's going on 
. I mean, who decides when an algorithm is 'hallucinating' or not? 
Those are some pretty high stakes decisions to be made by a machine. And what about bias? If AI can reinforce discriminatory patterns, how do we know it won't just make things worse for certain groups of people? We need more transparency and regulation in this space before we let AI take the reins 
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. And have you seen those AI chatbots? They're always asking you the same questions over and over again 
. It's like they're not even listening to what you're saying. And don't even get me started on bias... if an AI is gonna be used in healthcare, it needs to be transparent about its limitations and potential for error 
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. We need to have more transparency about how AI is being used in healthcare and make sure we're not just relying on technology to fix our problems without thinking critically about the consequences 
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. Anything less would be, like, totally unacceptable 
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. We need to make sure that these tools are being used in conjunction with human judgment, not as a replacement 
. And what really freaks me out is the potential for bias and accuracy issues 
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. We need to be careful not to over-rely on machines and forget about the importance of human interaction 
. But at the same time, I'm excited about the potential for AI to improve the patient experience and overall provider experience 
. Let's just hope we get it right 
!
Can't even get a straight answer from these chatbots anymore? I tried asking this one an easy question about my deductible, and it just spit out some nonsense about "algorithmic analysis" instead of giving me a clear answer. And don't even get me started on the Sheer Health app - $20 a month for someone to do my paperwork for me? No thanks! 
. I'm all for innovation, but we need to make sure it's used in a way that prioritizes patient care and understanding over just spitting out numbers 
Let's not forget that humans are good at empathy and compassion – things AI just can't replicate yet 
. We need to find a way to make AI work for us, not against us. Maybe it's about creating systems where humans and machines collaborate? 
. On one hand, it can help process claims and make decisions faster and more accurately than humans 
. But on the other hand, it's also being used to replace human decision-making which is a major concern for me 
. I think we need to have more transparency about how AI is being used in healthcare so we know what's going on behind the scenes 
. It's all about finding that balance, you know? 
. I mean, it's cool that tech can help speed up claims processing and stuff, but what about when humans aren't around to actually care? I've seen stories where AI makes mistakes and patients get denied care because the system can't handle complex situations. It's like, yeah, AI is great for simple things, but for real medical decisions, we need humans who know what they're doing 
- it can help process tons of info really fast, so we don't have to wait forever to get answers about our claims or insurance stuff. And it's actually helping patients connect with their health accounts and stuff, which is a total win! 
but it also brings concerns about bias & accuracy 
. We need more transparency from insurers & healthcare providers on how they're using AI & human oversight 
. The key is finding the right balance between tech & human touch in healthcare 
and I was thinking about how food is super important when traveling. Like, you can't just eat anywhere, right? And have you tried those new avocado toast places that are popping up everywhere? 
And on a completely unrelated note, have you seen those cute dog videos that go viral online? 
. Like, who gets to decide how AI makes decisions? Insurance companies or doctors? And what if they're biased? That's a major concern for me 
. If we're gonna use AI in healthcare, we gotta make sure it's not just a fancy calculator that spits out answers