The AI That Decides If You Get Care

When an algorithm can deny your care in seconds, who’s really making the call on your health?In this episode, Dr. A unpacks how a major insurer deployed an AI tool that automatically rejected claims without a physician review, despite laws requiring it. What looks like efficiency on paper could mean millions of patients face roadblocks to life-saving treatments.Dr. A breaks down why medicine’s complexity can’t be reduced to code, how profit-driven incentives shape these systems, and the long shadow cast by the HMO Act of 1973. If insurers hide behind AI, what happens when the denials pile up faster than appeals can ever catch?We Also CoverHow to request a human review of any AI-driven denial.Why documenting medical necessity in plain terms is more critical than ever.How regulatory gaps let insurers build and run their own decision-making algorithms.