Analysis ·
Hospitals use AI to diagnose, and insurers are not pleased
Original title, in Spanish: “Los hospitales están utilizando IA para diagnosticar. Y a las aseguradoras no les está gustando nada”
- Publication
- Xataka (Spain)
- Author
- Rubén Andrés
- Published on
- 6 October 2026 · read in the page structured data
Summary
In the United States, hospitals and health insurers are each using AI at opposite ends of the medical billing chain, according to a New York Times report picked up by Xataka. Hospitals use software that analyses test results, medical notes and patient histories to justify more costly secondary diagnoses: the McLaren group in Michigan is reported to earn an extra million dollars in monthly revenue as a result. A report by the insurer BlueCross puts this additional cost at $942 million between 2023 and 2025, of which 70% is linked to secondary diagnoses that reclassify the admission. In response, insurers use AI to detect irregularities and deny more payments: UnitedHealthcare had already denied 22.7% of post-hospitalisation care requests in 2022, according to the US Senate. The consultancy Marsh forecasts an 8.2% rise in healthcare costs per employee in 2027.
Summary based on the full text of the article.
Read the article on Xataka →Figures cited
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942 millions of dollars
Estimated additional spending from diagnoses of complex conditions in the US, 2023-2025
United States, 2023-2025
« el número de pacientes diagnosticados con afecciones complejas parece haber supuesto un gasto adicional estimado de 942 millones de dólares en atención médica entre 2023 y 2025, provocando un aumento de las primas para las familias, los empleadores y los contribuyentes »
Source: Informe de BlueCross
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70 %
Share of patients whose secondary diagnosis raised the billing category to a more costly level
United States, Medicare patients, 2023-2025
« Cerca del 70% de esos pacientes venía de diagnósticos secundarios que subían el ingreso a una categoría más cara. »
Source: Informe de BlueCross
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1 million dollars per month
Additional monthly revenue for the McLaren hospital group from using AI to manage diagnoses
McLaren, Michigan, United States
« el grupo hospitalario McLaren que opera en Míchigan, ingresa un millón más al mes gracias al uso de IA en la gestión del diagnóstico de sus pacientes. »
Source: The New York Times
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22.7 %
Denial rate of post-hospitalisation care requests by UnitedHealthcare under Medicare Advantage, 2022
UnitedHealthcare, Medicare Advantage, United States, 2022
« El Senado de EEUU documentó que UnitedHealthcare denegaba en 2022 un 22,7% de las peticiones de cuidados tras el alta en Medicare Advantage. »
Source: Senado de EE. UU.
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8.2 %
Forecast rise in healthcare costs borne by each employee in 2027
United States, forecast for 2027
« La consultora sanitaria Marsh (antes Mercer) prevé que el coste de salud que deberá pagar cada empleado suba un 8,2 % en 2027, el mayor salto desde 2003. »
Source: Marsh (anciennement Mercer)
Classification
- Country
- United States
- Company size
- All sizes
- Industries
- Healthcare, pharmaceuticals, social care · Banking, insurance, asset management, finance departments
- Companies
- American Hospital Association (AHA) (cited), Marsh (study author), Peterson Health Technology Institute (study author), BlueCross (study author), McLaren (deploys AI), UnitedHealthcare (deploys AI)
- Keywords
- healthcare, health insurance, medical billing, AI diagnosis, reimbursement, hospitals
Entry written by Marsanne Studio from the cited article, with the help of an AI model (claude-sonnet-5). The rights to the article and its illustrations belong to Xataka and its author. Entry translated from French by Claude Sonnet 5.5.