In 2023, the ten largest health insurance companies in the United States reported a combined profit of $45.3 billion, surpassing even the tech giant NVIDIA in terms of net income. UnitedHealthcare alone posted $22 billion in profit, with $5.5 billion of that in the last quarter. However, these impressive figures weren’t the result of offering better services or improving patient care. Instead, insurance companies have implemented artificial intelligence (AI) algorithms designed to deny claims and avoid paying for treatment, ultimately boosting their profits at the expense of those in need of healthcare.
To understand how this process works, it’s essential to break down the structure of the insurance industry. The goal of insurance companies is to maximize the number of policies sold while minimizing the number of claims they approve. The difference between the premiums collected and the claims paid out is the key to their revenue. In other words, the more claims they can deny, the higher their profits.
ProPublica recently exposed a shocking practice: the insurance giant Cigna Healthcare, for example, denied more than 300,000 claims on average every two months, spending just 1.2 seconds per claim. Doctors employed by the company were able to process up to 50 rejections in just 10 seconds, thanks to AI-powered algorithms designed to streamline the process and save the company millions of dollars by denying payouts.
UnitedHealthcare has gone even further, integrating a system called nHPredict, which uses predictive algorithms to determine who is likely to survive and who is not. Based on these predictions, the system decides which patients will be denied coverage for life-saving treatments, all calculated based on survival probabilities. Though nearly 90% of these denials are overturned by federal courts, by the time the legal process is completed, many of the patients have already passed away. In these cases, patients are often subjected to years of appeals — sometimes up to 2.5 years — all while the insurance company’s algorithm determines that the patient is unlikely to survive long enough to see a resolution.
Hospital executives have revealed that insurance companies deliberately set up appeals processes that stretch for years, knowing full well that patients with terminal conditions won’t live long enough to see their appeals resolved. This practice is a way for insurance companies to avoid paying out for treatments and to increase their bottom line without facing immediate repercussions.
Vanity Fair concluded that the rapid advancement of technology in the insurance industry has turned human lives into little more than figures in a spreadsheet. What was once a system designed to provide support and security to patients has now become a cold, calculated process where profits are prioritized over the well-being of individuals.