Two U.S. senators are requesting information from UnitedHealthcare, Humana, and CVS Health regarding their use of artificial intelligence and other automated technologies in Medicare Advantage prior authorization and post-acute care coverage decisions. The inquiry follows recent federal oversight reports that examined denial rates and prior authorization practices among Medicare Advantage plans.
Lawmakers are seeking details on how these insurers use AI, algorithms, or predictive technologies to support coverage determinations, as well as the safeguards in place to ensure clinical oversight. The request also follows recent reports highlighting higher denial rates for certain post-acute care services and ongoing discussions about the role of automation in healthcare decision-making.
The insurers have stated that coverage decisions are made in accordance with CMS guidance and involve clinician review, while industry groups have emphasized that prior authorization decisions require additional context beyond the federal reports. As congressional and regulatory scrutiny continues, providers participating in Medicare Advantage plans should monitor future developments that could influence prior authorization requirements and oversight.
Resource: Senators press UnitedHealth, Humana, CVS on AI-driven Medicare Advantage coverage decisions