Major health insurance companies in the United States are increasingly relying on artificial intelligence to cut costs and streamline operations — but this trend is raising serious concerns among healthcare providers about trust, transparency and patient care. According to a new STAT report, insurers such as UnitedHealth Group have publicly touted AI as a key productivity enhancement, even promising it could help cut billions in costs, yet providers and clinicians say these systems are diminishing confidence in decision-making and oversight.
Clinicians argue that when insurers deploy AI for administrative and clinical decisions — including claims processing, utilisation reviews, and care authorisations — it can disrupt longstanding relationships between doctors and payers. Providers report that AI-driven tools often lack transparency about how decisions are reached, making it difficult to challenge or understand coverage denials and other outcomes that directly impact patient care and treatment paths.
Critics also note that because health insurers often don’t disclose how their AI systems are built, what data they use, or how they’ve been tested, providers and patients are left in the dark about the reliability and fairness of these tools. This opacity can erode trust not just in specific decisions, but in the broader system of care coordination and insurance adjudication — especially when automated decisions carry high stakes for individuals’ access to necessary services.
Allied concerns come at a time when regulators and lawmakers are beginning to scrutinise AI use in insurance more closely, with some calls for stronger oversight, clearer governance and safeguards to ensure that automated tools enhance rather than undermine clinical judgment and equitable treatment. Experts argue that balancing the efficiency gains from AI with accountability and trust will be essential for the technology to deliver value in healthcare without compromising patient outcomes.
