I’ve been looking into the latest healthcare policies, and I have some concerns regarding their effects on Medicare beneficiaries. There are discussions about using AI technology to determine if Medicare will sanction certain procedures and treatments.
Can anyone shed light on how these AI systems are expected to function? Will they eliminate the need for human reviewers entirely, or will they simply be a tool for them? What are the implications if AI mistakenly denies a treatment that should be covered?
I’m particularly anxious about older individuals who may find it challenging to navigate the process of appealing these automated decisions. Has anyone had experience with similar automated decision-making in healthcare? What should patients anticipate, and how can they get ready for these upcoming changes?
Any information or personal stories would be greatly appreciated, as this situation could impact countless people relying on Medicare.
yeah, this worries me too. my mom dealt with her insurance company’s automated system last year - total nightmare trying to reach real people. sure, AI might handle simple stuff faster, but what about when it screws up? older ppl shouldn’t need to become tech wizards just to get the healthcare coverage they’ve earned.
Worst possible timing for this rollout. My state switched Medicaid to automated prior auth last year - accuracy wasn’t awful, but the failures were spectacular. Here’s what blindsided people: you’ve got limited days to appeal, and most elderly patients don’t know the clock starts immediately. AI systems really struggle with complex medical histories that are super common in Medicare populations. My 78-year-old neighbor got her routine procedure denied because the system couldn’t figure out her medication interactions - which actually made the treatment MORE necessary. These systems learn from historical approval patterns, so they just repeat the same coverage biases we’ve always had. If this is coming your way, make sure your doctors document everything upfront. Don’t count on common sense winning with automated reviews.
I’ve worked with automated decision systems for years, and the Medicare AI rollout is following the same playbook.
These systems won’t replace human reviewers - they’ll approve straightforward cases and flag weird stuff for humans. Problem is, “weird stuff” usually means complex medical situations that hit older patients hardest.
I’ve seen this before. The AI approves routine cases fast but creates bottlenecks for anything unusual. Think spam filters - great for obvious junk, but they catch real emails too.
Appeals are where it gets messy. Most people don’t know they can appeal, and the process sucks. My advice? Document everything, get your doctor to clearly explain medical necessity, and escalate if you get denied.
Helps to understand how these systems work. Here’s a good breakdown of automated decision systems:
These systems are coming whether we want them or not. You need to know how to work with them and when to fight back through the right channels.
