Medicare Advantage AI Tools Stripping Care from Older Adults

Medicare Advantage insurers, like many payers, are increasingly relying on artificial intelligence (AI) to make reimbursement decisions, resulting in some older adults being denied access to adequate care. The tools are used to determine exactly when the plan can stop paying for care, often long before it is medically advisable to pull back.

According to Casey Ross and Bob Herman, “Behind the scenes, insurers are using unregulated predictive algorithms, under the guise of scientific rigor, to pinpoint the precise moment when they can plausibly cut off payment for an older patient’s treatment. The denials that follow are setting off heated disputes between doctors and insurers, often delaying treatment of seriously ill patients who are neither aware of the algorithms, nor able to question their calculations. Older people who spent their lives paying into Medicare, and are now facing amputation, fast-spreading cancers, and other devastating diagnoses, are left to either pay for their care themselves or get by without it. If they disagree, they can file an appeal, and spend months trying to recover their costs, even if they don’t recover from their illnesses.”

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(Source: STAT, March 13^th, 2023)