The upshot of those additional payments made to hospitals: higher insurance premiums for you and me. <\/p>\n
And the insurers contend that patients did not receive any extra treatments for the extra billings. <\/p>\n
“Our research showed that there was a change in the way patients were coded, but no evidence of a corresponding change in the care delivered,” David Merritt, senior vice president of external affairs at the Blue Cross Blue Shield Association, told Yahoo Finance.\u00a0 <\/p>\n
More data, more diagnoses, higher bills <\/p>\n
The analysis of claims data between 2023 and 2025 found that “as more hospitals apply AI coding tools, an increasing number of patients are coded as medically complex.”\u00a0 <\/p>\n
Blue Cross Blue \u200bShield Association’s network<\/a> of independent health insurance companies covers 1 in 3 Americans.\u00a0 <\/p>\n Using AI tools, hospitals are vacuuming up more information about their patients and submitting fatter claims, according to the BCBSA findings.\u00a0 <\/p>\n What that means is that patients often fall into a higher-cost billing category after a secondary diagnosis, flagged by AI, in addition to the condition that brought them in originally. <\/p>\n The secondary diagnoses for conditions like low sodium or anemia move the claim into a higher-paying category, according to the analysis.\u00a0 <\/p>\n Read more:\u00a0What is a healthcare FSA? How to save on medical costs.<\/a> <\/p>\n AI-assisted billing software scans records and lab data for anything that can be coded, according to the research. With a majority of hospitals now tapping AI coding tools to document patient appointments and dissect lab tests and physicians’ notes, insurers are responding by upping premiums. <\/p>\n “When the same care costs more, it flows through the system, driving up premiums and out-of-pocket costs for families who are already struggling with higher prices,” Merritt said. <\/p>\n Soaring healthcare premiums are a serious concern for Americans.\u00a0 <\/p>\n The median proposed premium increase for 2027 is 15%, according to an analysis<\/a> from the healthcare research nonprofit KFF.\u00a0 That’s likely to be the second consecutive year of double-digit premium hikes. This year, the median rate increase was 20%. <\/p>\n Just as hospital providers are leaning on AI tools to justify more medical care, insurance companies are also accused of using the tools to delay or deny care.\u00a0 <\/p>\n The companies have come under sharp criticism for their use of AI in requiring prior approval for treatments and medicines.\u00a0 <\/p>\n A new pilot program in Medicare, for instance,\u00a0relies on sophisticated technology to help determine certain kinds of care. <\/p>\n Though traditional Medicare beneficiaries generally don’t need prior authorization before receiving medical treatment, a new program<\/a> launched by the Centers for Medicare and Medicaid Services (CMS) began implementing prior authorization<\/a>, including the use of artificial intelligence to review requests for care. <\/p>\n The program, known as the Wasteful and Inappropriate Service Reduction (WISeR) model, requires additional approvals for a range of procedures<\/a>, including epidural steroid injections, treatments for spinal stenosis and knee osteoarthritis, and nerve stimulation for conditions such as tremors and Parkinson’s disease. <\/p>\n According to CMS records<\/a> from a lawsuit against WISeR \u2014 along with the previous reporting \u2014 this model has continued to result in delays and denials of care. <\/p>\n “AI in healthcare is quickly turning into a battle between providers and payors, with patients caught in the middle,”\u00a0 said Eric Miller, a vice president and actuary at Segal, which consults with companies on their benefits. “Ultimately for individuals, this has the likely outcome of increasing costs and premiums at a time when trends are already historically high.” <\/p>\n Kerry Hannon is a Senior Columnist at Yahoo Finance. She is a career and retirement strategist and the author of 14 books, including “Retirement Bites: A Gen X Guide to Securing Your Financial Future,<\/a>” “In Control at 50+: How to Succeed in the New World of Work<\/a>,” and “Never Too Old to Get Rich.” Follow her on Bluesky<\/a> and X.<\/a> <\/p>\n<\/a> Westend61 via Getty Images Insurers embrace AI too <\/p>\n