ASA DEN'AI'LI

Name changes, like the recent reversion of Alaska’s Denali back to its former name, Mount McKinley, are seen as a current form of power expression in America. However, let’s consider a different kind of power flex that could benefit foot and ankle healthcare providers. This involves challenging the opaque artificial intelligence (AI) algorithms that are increasingly responsible for insurance denials and pre-authorizations. By advocating for transparency and fairness in the systems, we can work towards better outcomes for both providers and patients.

California's got it going

In recent years, insurance companies have increasingly relied on AI to process claims and prior authorization requests. However, the new Physicians Make Decisions Act (SB 1120) mandates that licensed healthcare providers, not AI algorithms, must make decisions about medical treatments. 

Next up federal court

On Feb. 13, the Minnesota federal court permitted allegations of breach of contract and breach of the implied covenant of good faith and fair dealing to proceed. The focus is on whether the insurer honored its contractual obligations. The lawsuit challenges the use of a predictive algorithm which the plaintiffs claim overrides physicians’ decisions.