Some insurers denied unusually high number of claims

As another example of how automation can benefit a company, but create more hassle for its customers, KFF Health News published an article about how some insurers seem to be rejecting claims in bulk (one insurer denied 49% in 2021 and another denied 80% in 2020). The author collected some cases where the rationale for the rejections did not make sense (e.g. including rejecting a procedure that was not actually claimed).

Presumably, some patients will be too busy to contest the rejections and the insurers in question will benefit financially. Even if all of the wrongful rejections were ultimately resolved correctly, patients and providers still end up spending time (and maybe even money) to challenge the rejections. Assuming that these rejections were due to software that streamlines the process, automation in this case works asymmetrically in favor of the company (saving on some claims) while pushing additional administrative burden on others. If insurers were responsible for meaningfully compensating patients for lost time in challenging a rejection, they would probably be much more careful about their rejections.

The article ends with a discussion about the government being tasked with oversight and enforcement, but not actually doing so. Given the lack of penalties, it is perhaps not surprising that some insurers might test the boundaries to see how they can benefit.