The Trump administration is planning a pilot program in six states that will introduce the type of pre-authorization review process for Medicaid and Medicare services that already happen — and have been roundly criticized — in the private sector.
To put it simply, Trump is taking the most cumbersome part of private insurance and applying it to Medicare. Not only is pre-authorization cumbersome, it often results in a denial of treatment, sometimes for no clear reason.
Trump’s pilot program aims to circumvent the inefficiency of pre-auth by injecting artificial intelligence into the equation. That’s right. Next time you’re denied services, you could have an AI to thank.
In fact, private insurers like Cigna and UnitedHealth have already begun incorporating AI into the process, with often disastrous outcomes. Some reviews have shown that pre-authorization is already shoddy, sloppy, and quick. One study found that reviewers have spent as little as one second reviewing each case that comes before them. AI will turbocharge that process, allowing insurers to deny potentially thousands of claims every second.
And when a machine denies your coverage, who do you hold accountable for mistakes?
The motive comes down to profit, obviously. Clearly, when an insurer overrides a doctor’s prescribed treatment, it doesn’t have to pay for said treatment. But Medicare and Medicaid are not private insurers and should not necessarily operate exclusively to profit off subscribers.
Ryan Clarkson, managing partner at Clarkson Law Firm in Malibu, is representing clients whose treatments have been declined using AI. He joined Sam Osterhout to dig into what’s going on, who’s affected, and the potential for catastrophe with Trump’s pilot.
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