US insurers and hospitals turn to new AI for age-old battle over charges vs payments | WKZO | Everything Kalamazoo
Publish Date: 2026-03-12 07:22:00
Source Domain: wkzo.com
- Insurers are using AI to verify the necessity of medical procedures and to identify potentially unwarranted treatments and bills while hospitals use AI tools to document codes that increase reimbursement, leading to a tug-of-war over medical costs.
- AI deployment has led to concerns regarding aggressive or improper use of coding software for reimbursement, such as instances of exaggerated medical diagnoses being coded.
- Both insurers and hospitals expect AI to help drive down costs, with McKinsey estimating AI could save insurers $970 million for every $10 billion in revenue and hospital care savings potentially reaching $900 billion by 2050.
- While hospitals have spent more on healthcare AI, with $1.4 billion invested in 2025, companies like UnitedHealth Group and Humana have plans to invest heavily in AI to realize savings.
- The use of AI by both healthcare providers and insurers has led to growing friction in the industry, with AI effectively fueling an “AI versus AI” battle over medical payments and reimbursement.
