Take Me to Your ̶L̶e̶a̶d̶e̶r̶ Insurer

CMS just greenlit a new Medicare model that hands private insurers even more authority to deny coverage, now supercharged with AI. Translation: the government outsourced life-or-death decisions to algorithms trained by corporations whose profit depends on saying no.

The Center for Economic and Policy Research laid it out plain. Insurers can now deploy automated systems to scan claims, flag them, and spit out denials at scale. Instead of fighting with a single claims rep, patients and doctors will fight with machines programmed to save insurers money. Appeals already take months, and most patients give up before they win. Layer AI on top of this, and you’ve created a denial factory.

Medicare was designed to guarantee access. This move erodes that core promise. We already know how insurers behave without AI. They deny rehab for stroke patients, chemo for cancer patients, wheelchairs for people with paralysis. They call it “not medically necessary.” Now the decision can be made instantly by an algorithm trained to hunt for patterns that trigger rejection.

If you think doctors or patients will have time to push back, you haven’t lived in the system. I have. As a 29-year survivor, I’ve watched billing departments run out the clock on desperate families while collections pile up. I’ve sat with patients who ration meds because their insurer claimed a lifesaving drug wasn’t covered. It’s not a hypothetical. It’s Tuesday in America.

The worst part? CMS calls this “innovation.” They claim AI will reduce costs. But cost savings don’t come from healthier patients. They come from denial. Every dollar saved is a dollar stolen from someone’s care. That’s not efficiency. That’s cruelty with a user interface.

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SOURCE ➡️ https://cepr.net/publications/denying-coverage-with-ai-cmss-new-medicare-model/