7 in 10 patients concerned AI will drive unfair claims denials

Patients say health plan use of AI can be helpful

AI has become more than just a buzzword in healthcare. More and more payers and providers are leveraging the technology to drive efficiency and ease access for healthcare consumers.

According to May 2025 figures from the National Association of Insurance Commissioners, 84% of health insurers are using AI and machine learning in some capacity. Specific use cases include utilization management, implementing of disease management programs, prior authorization processes, fraud claim detection, medical provider fraud detection and enhancing of online sales or consumer shopping experience.

This can be a good thing, patients said in the Pollfish/Zyter|Trucare survey.

For example, 65% said they like seeing their health plan use AI for functions like claims processing and prior authorization. Another 45% said that AI would be valuable if it could speed up authorizations and reduce delays in care.

Still, technology experts know that there are risks associated with AI use. According to the survey, patients know it, too.

Patients worried about AI fairness

Notably, patients are worried about whether AI will be fair in adjudicating claims, with 67% saying as much. Another 44% are worried about fairness and accuracy.

Half of the respondents said they trust a human claims analyst more than AI.

These findings come as news reports center on the unfair use of AI to deny certain claims and authorizations.

In October 2024, the Senate issued a report stating that Medicare Advantage plans such as UnitedHealth, CVS and Humana used predictive technology to deny claims and prior authorizations for post-acute services.

And in November 2023, UnitedHealth faced a lawsuit claiming the payer used AI it knew to have a high error rate to deny coverage for Medicare Advantage members.

These types of reports might be fueling consumers' hesitation around payer AI use. Although AI is lauded for increasing efficiency -- which is essential for patients waiting on prior authorization approvals -- it has also been documented to unfairly deny people care.

Patients want clear explanations of AI use

Consumers want their payers to be clear with them about when and how they use artificial intelligence, the Pollfish/Zyter|Trucare poll showed.

For example, two-thirds of consumers said they want to be notified in plain language when their payer is using AI. Conversely, only 6% said they don't need to know when AI is in use.

Indeed, that "plain language" requisite is essential. Healthcare payers using AI should ensure all communication about the technology is written with patient health literacy in mind and outlines exact use cases, benefits and safeguards around the tool, experts advise.

Sara Heath has reported news related to patient engagement and health equity since 2015.