Health insurers are under legal pressure over their use of artificial intelligence (AI) to deny medical claims, according to recent reports. UnitedHealth Group, the largest health insurer in the U.S., is facing a class-action lawsuit that accuses it of using AI to reject necessary care, even when doctors recommend it. Similar legal challenges are also being brought against Humana and Cigna, who are accused of using AI systems to make coverage decisions. These cases involve families seeking care for elderly loved ones after serious health events, only to be denied coverage by automated systems. Doctors have reported troubling instances where patients required extended rehabilitation but were cut off from care after only a few weeks by AI algorithms. Medicare, the federal health insurance program for seniors, has also introduced an AI tool to assist in prior authorization decisions—processes that require approval before certain treatments are covered. However, some patients have faced severe health issues or distress after their claims were denied by these systems. One of the most publicized cases involves Gene Lokken, a 91-year-old man who was denied further nursing care after an AI algorithm called nH Predict determined it was no longer necessary. Lokken’s family had to pay between $12,000 and $14,000 monthly to keep him in a nursing facility, and he died in July 2023 without ever leaving the facility. Similar cases have involved other patients, such as Glennette Kell, who was denied nursing care after a fall, and Darlene Buckner, who was denied treatment after heart surgery. UnitedHealth maintains that doctors are ultimately responsible for claims decisions, but plaintiffs argue that employees are instructed not to override AI-generated rulings. Humana is also being sued over its use of the same nH Predict algorithm, with one case involving Joanne Barrows, an 86-year-old woman denied care after a fall. Cigna is facing legal action for using a different AI tool that allowed doctors to deny claims in bulk if they didn’t meet specific criteria. In one instance, a patient’s claims for ovarian cancer scans were denied, leading to significant out-of-pocket costs. The Trump administration introduced AI into traditional Medicare and Medicaid through the WISeR model, which uses machine learning to handle prior authorization decisions. However, physicians and patient advocates have raised concerns about the program’s impact, citing reports of delayed or denied care. The Electronic Frontier Foundation obtained documents showing that AI has led to aggressive denials and delays in approvals. Experts warn that the use of AI in healthcare is expanding rapidly, but regulatory oversight is struggling to keep pace. While AI has the potential to improve healthcare efficiency, its role in insurance claims processing has raised serious questions about the fairness and accuracy of automated decisions. Legal experts stress the need for human oversight in AI-driven systems, but defining what constitutes meaningful human involvement remains a challenge. Until clear regulations are in place, individuals are advised to appeal denied claims, as many are overturned on appeal. Advocates are pushing for legislative action to ensure that AI use in healthcare is transparent and subject to human review.