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UnitedHealthcare's AI missteps a cautionary tale for banks

Dec 12, 2024 - americanbanker.com
The article discusses the controversial use of AI in health insurance and banking. UnitedHealthcare has faced criticism and legal action for using AI to deny healthcare coverage, particularly affecting elderly and mentally ill patients. Reports indicate a significant increase in denial rates for post-acute care, with AI models allegedly overriding physicians' decisions. Critics argue that insurers use AI to cut costs, leading to inappropriate denials and financial burdens on patients. The article highlights the ethical concerns and lack of regulation surrounding AI's role in healthcare decisions.

In contrast, banks have been more cautious in adopting AI, primarily using it for fraud detection and customer service. Regulatory frameworks like the Equal Credit Opportunity Act ensure fairness in lending, preventing discrimination. Some banks, like Verity Credit Union, use AI to expand credit access to underserved groups, showing positive outcomes. Experts argue that the issue lies not with AI itself but with the incentives and oversight in its deployment. While AI can improve decision-making, its use in insurance and banking requires careful regulation to ensure fairness and accountability.

Key takeaways:

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  • UnitedHealthcare faced criticism for using AI to deny health care coverage, particularly affecting elderly and mentally ill patients, leading to a significant increase in denial rates.
  • A class-action lawsuit was filed against UnitedHealthcare for allegedly using AI to override physicians' decisions, resulting in wrongful denials of care under Medicare Advantage Plans.
  • Banks are more cautious in using AI due to heavy regulations like the Equal Credit Opportunity Act, which ensures non-discrimination in lending decisions.
  • While AI can potentially harm lending practices, it also offers opportunities for fairer credit assessments, as demonstrated by Verity Credit Union's increased loan approvals for diverse groups.
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