April 10, 2026
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This year, executives from nearly every major health insurance company made the same declaration in calls with Wall Street analysts: Using artificial intelligence to make coverage decisions would help save them money.
Even the Trump administration is testing AI’s usefulness in managing the prior authorization process for the Medicare program, as well as seeking to override AI regulation by states.
But class action lawsuits have accused insurers of using AI to wrongfully withhold treatment. And new research from Stanford University outlines the risks of training AI on a current system rife with wrongful denials.
“There is a world in which using AI could make that worse, or at least replicate a bad human system, because the data that it would be training on is from that bad human system,” said Michelle Mello, a co-author of the study.
Although, Mello said, the research team found “real positives alongside the risks.”
In this video produced by KFF Health News’ Hannah Norman, Darius Tahir, a correspondent covering health technology, explains.
You can read Tahir’s recent coverage of AI’s use by health insurers below:
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