Vol. 126 No. 1
AI-GENERATED DENIALS: MEDICAL NECESSITY IN MEDICARE ADVANTAGE TODAY
Medicare Advantage insurers hold vast power over access to care for Medicare beneficiaries enrolled in their plans. Among other things, these insurers make the all-important determination as to whether care is “medically necessary” and thus warrants coverage under Medicare. Recently, these insurers have turned to artificial intelligence to help with these determinations. This trend has yielded concerning results, exacerbating both inaccuracy[...]