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BumRushDaShow

(160,763 posts)
Wed Sep 24, 2025, 08:11 AM Wednesday

Private health insurers use AI to approve or deny care. Soon Medicare will, too.

Source: NBC News

Sept. 24, 2025, 5:00 AM EDT


Taking a page from the private insurance industry’s playbook, the Trump administration will launch a program next year to find out how much money an artificial intelligence algorithm could save the federal government by denying care to Medicare patients.

The pilot program, designed to weed out wasteful, “low-value” services, amounts to a federal expansion of an unpopular process called prior authorization, which requires patients or someone on their medical team to seek insurance approval before proceeding with certain procedures, tests, and prescriptions. It will affect Medicare patients, and the doctors and hospitals who care for them, in Arizona, Ohio, Oklahoma, New Jersey, Texas, and Washington, starting Jan. 1 and running through 2031.

The move has raised eyebrows among politicians and policy experts. The traditional version of Medicare, which covers adults 65 and older and some people with disabilities, has mostly eschewed prior authorization. Still, it is widely used by private insurers, especially in the Medicare Advantage market.

And the timing was surprising: The pilot was announced in late June, just days after the Trump administration unveiled a voluntary effort by private health insurers to revamp and reduce their own use of prior authorization, which causes care to be “significantly delayed,” said Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services. “It erodes public trust in the health care system,” Oz told the media. “It’s something that we can’t tolerate in this administration.”

Read more: https://www.nbcnews.com/health/health-care/private-health-insurers-use-ai-approve-deny-care-soon-medicare-will-rcna233214

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hlthe2b

(111,495 posts)
1. I am firmly convinced that AI, like paid individuals, can render any result you want if programmed
Wed Sep 24, 2025, 08:16 AM
Wednesday

to do so. I always wonder why AARP is still around, given that they have done NOTHING to support their older constituency against the attacks on Social Security and Medicare for decades now against RW assaults. Sadly, a lot of older people are not computer literate nor understanding of the risks AI can render.

It behooves ALL of us to fight back on this. Call Congress.

Bengus81

(9,450 posts)
8. Yep...I've been a member of AARP for a decade and they've really printed nothing about Trump
Wed Sep 24, 2025, 09:32 AM
Wednesday

Musk and their attacks on Medicaid,Medicare and SS. My sub runs out in 2026 and that will be that. Pretty soon they'll start running articles on steps people can take to like on less SS and NO Medicare.

gab13by13

(29,877 posts)
2. Remember now, Krasnov follows Hitler's playbook.
Wed Sep 24, 2025, 08:21 AM
Wednesday

Call it what you like, eugenics, like Hitler's master race, depopulation, genocide, the people behind Project 2025 want to murder millions of people here and around the world.

That Big Ugly Death Bill is going to kill or shorten the lives of unwashed Americans. When the next Covid or other disaster hits, the rich can afford a medical cocktail for treatment, we unwashed Americans will be told to take horse paste or drink bleach, or shove ultraviolet lamps up our asses.


not fooled

(6,478 posts)
13. Acting president Stephen Miller wants 100 million in the USA
Wed Sep 24, 2025, 11:54 AM
Wednesday

Krasnov has been quoted saying this. I have no doubt that's their goal. Attrition + targeted neglect are the means.

OldBaldy1701E

(9,135 posts)
5. I see.
Wed Sep 24, 2025, 09:13 AM
Wednesday

Making sure that your insurance company-owning friends have precedence for making their AI's even tougher on 'approving' anything, eh?

I can hear them plotting now.

"Since the Feds can do it..."

IronLionZion

(49,971 posts)
6. They're super efficient at killing Americans
Wed Sep 24, 2025, 09:21 AM
Wednesday

Saving money by denying care. And then give big tax cuts to billionaires.

Make intelligence real again

Scalded Nun

(1,514 posts)
9. Save Money on Medicare Services equates to Denial of Healthcare Services
Wed Sep 24, 2025, 09:50 AM
Wednesday

Last edited Wed Sep 24, 2025, 12:01 PM - Edit history (2)

As stated above, you can program AI to give you exactly the result you want it to give you.

You can also be assured that it will be perverted by those who control its programming.

Attilatheblond

(7,336 posts)
11. And.... insurance companies save money by not having to pay quack doctors to deny services now.
Wed Sep 24, 2025, 10:50 AM
Wednesday

CEOs pick decision makers who make shareholders happy then shareholders make CEOs happy. It's a circle jerk that costs lives.

slightlv

(6,619 posts)
10. Well, here's where their Death Panels really get going!
Wed Sep 24, 2025, 10:20 AM
Wednesday

Elderly and need cancer care? Drug costs too high for your autoimmune disease? Cost Benefit Ratio AI's say it's cheaper just to let you die. Brave New World, people.

LatteLady

(85 posts)
12. We are less expensive dead.
Wed Sep 24, 2025, 11:08 AM
Wednesday

The government could use AI to improve patient outcomes. But no. It’s all about the $$$ while billionaires get tax cuts.

I’m especially concerned because many chronic conditions seen in older adults cannot be “cured” and have to be managed long term. Will they define tests and treatments that do not “cure” to be wasteful?

Also worried that the high variability in response to treatments seen in groups of older adults means that the “average” response to a treatment may be used for AI decision making despite being accompanied by subgroups of patients that respond very well. Will all older adults, including those individuals who might really benefit, be denied a certain treatment because the average response is not stellar?

Also worried that they’re very aware Medicare would save a lot of money if older people would just die versus needing health care.

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