Insurers using AI and algorithms to deny claims; Sen. Elizabeth Warren calls on Biden to address Medicare Advantage profiteering

I apologize for being MIA for the past several days, but Covid finally caught up with me and I just haven’t had the energy to do much of anything since I tested positive in mid-March. 

Even with Paxlovid, my recovery has been slow and in fits and starts. Last Monday I thought I had fully recovered, but I hit a wall on Tuesday. My energy level can be reasonably high one day and low the next. 

I’ve been fortunate in that I’ve never been very sick before. If there is a positive takeaway from my Covid experience, it’s that I now know what it’s like for so many Americans to try to navigate our absurdly complex and profit-driven health care system when you can barely find the strength to get out of bed. Dealing with a health insurance company is the last thing you need. Now I get why so few of us even bother to appeal a prior authorization or claim denial. 

Last Wednesday I made it to a theater in downtown Washington to moderate a panel after the premiere screening of a new documentary I helped produce, American Hospitals: Healing a Broken System. We had a full house, an indication that people are ready to at long last to do something about the unreasonably high cost of a stay in many U.S. hospitals. Today, I’ll be flying to Denver to moderate a panel after a screening of the movie there. Screenings are scheduled in several other cities–from LA to New York–in the coming days. For more information and a list of screenings, go to FixItHealthcare.com. I’ll write more about the movie in the days ahead.

While I was quarantining and recovering, I was gratified to see that the work we’re doing with this newsletter and our nonprofit advocacy arm, the Center for Health & Democracy, is getting noticed and paying off. 

Last week, Senators Elizabeth Warren and Jeff Merkley cited our analysis of the 2022 revenue and earnings reports of the seven big for-profit health insurers in a joint press release calling on Congress and the Biden administration to address the ongoing profiteering of those companies in the Medicare Advantage program. They noted, as we found, that the seven companies took in $1.25 trillion in revenue last year, made $69 billion in profits, and spent $26.2 billion buying back shares of their own stock. Sen. Warren also cited our analysis in letters she sent to the insurers’ CEOs. 

We’ll be writing more about the actions the Biden administration is taking regarding Medicare Advantage in the coming days. 

I was also pleased–but frankly horrified–to see a major investigative piece by ProPublica reporters that found that my former employer, Cigna, is using AI to instantly deny hundreds of thousands of claims without human review. I’ve been sharing insights with the reporters over the past several months and connecting them with other former insiders. One of the reporters, Maya Miller, appeared on PBS Newshour Sunday to talk about the report.

PBS NewsHour @NewsHour

Investigative journalists at ProPublica found that the insurance company Cigna is using artificial intelligence to assess, and often deny, claims in bulk. @AliRogin speaks to ProPublica's @mayatmiller to learn more.

And STAT published a blockbuster of a story by Casey Ross and Bob Herman about how Medicare Advantage insurers are using algorithms to cut off care for seniors in need. 

That’s all for now. I’ve run out of steam for the day, but little by little, I’m getting my strength back. I’ll be back in fighting shape soon!