Sen. Richard Blumenthal, D-Conn., the ranking member of the Senate Permanent Subcommittee on Investigations (PSI), is asking three major Medicare Advantage insurers to disclose whether they use artificial intelligence or other predictive technologies to make decisions about patient care.
In letters sent Oct. 9 to UnitedHealthcare, CVS, and Humana, Blumenthal requested information about the insurers’ use of AI, citing rising prior authorization denials.
The senator pointed to a recent survey from the American Medical Association, which found that 61% of physicians fear that insurers’ growing use of predictive technologies “is increasing prior authorization denials.”
“Despite the Subcommittee’s recommendation that insurers be required to report more data about the denials they issue and the role that AI plays in coverage determinations, regulators and the public remain woefully lacking in critical information needed to detect and curb harms resulting from misuses of the prior authorization process,” Blumenthal wrote.
“As a result, the American people continue to be reliant on little more than insurers’ promises that they are not taking potential life-and-death decisions away from doctors and giving them to machines,” he added.
Blumenthal is asking the three companies to respond to a series of questions to help the subcommittee assess how Medicare Advantage insurers are using AI to make health care decisions.
The senator wants to know if the companies use AI or other predictive technologies for final adverse determinations for Medicare Advantage beneficiaries. He also wants to know which AI or predictive technologies have been used by the companies for the evaluation of patient care or the payment for patient services.
Finally, he is requesting the insurers to describe any policies implemented in the last year “to prevent predictive technologies from unduly influencing the work of human clinicians.”
Blumenthal wants a response to his questions by Oct. 17.
The letters follow a year-long investigation by PSI that revealed prior authorization denial rates for admission to certain post-acute care facilities increased during the same period insurers were investing heavily in predictive technologies.
PSI released that report last October.
Throughout PSI’s investigation, UnitedHealthcare, CVS, and Humana denied that they used AI to make final decisions regarding patient care.