AI for better care: Your questions answered
What you need to know about artificial intelligence and how UnitedHealthcare is using it responsibly to help make the health system work better.
Artificial intelligence (AI) is a complicated concept for many to understand and can raise concerns and questions if used inappropriately, especially pertaining to its application in health care.
Our goal is to clarify some of those frequently asked questions, including how UnitedHealth Group and its businesses, UnitedHealthcare and Optum, are using it.
What is artificial intelligence (AI)?
AI performs tasks that typically require human intelligence, including learning, reasoning and making decisions based on data and algorithms. Generative AI is a type of artificial intelligence that involves creating new data or content, such as images, music or text, that did not previously exist. Unlike other types of AI, which are designed to recognize patterns in existing data and make predictions based on those patterns, generative AI can create new and original content.
Does UnitedHealthcare use AI to make coverage decisions?
No. Coverage decisions are made based on standard coverage criteria, medical necessity guidelines and the terms of member plans. AI is used to help inform providers, families and other caregivers about what sort of assistance and care a patient may need, whether in a health care facility or at home.
Does UnitedHealthcare use AI to make prior authorization decisions?
No. While UnitedHealthcare uses AI to gather clinical data and support clinical and administrative professionals throughout the decision-making process, UnitedHealthcare does not employ AI to issue any adverse clinical determinations.
Does UnitedHealthcare use AI to make clinical decisions?
Powered by its own data sets, UnitedHealthcare has developed AI solutions that help surface insights and information based on the latest medical knowledge, patient history and historical outcomes data. AI never replaces the health care provider’s decision – only enables it.
Does UnitedHealthcare use AI to recommend courses of treatment?
Algorithms surface relevant insights and recommend potential treatment options to providers based on evidence-based, clinical guidelines and outcomes data. However, all treatment decisions are made by clinicians, with AI used as a tool to assist/inform them.
Does UnitedHealthcare use AI to determine hospital or provider reimbursement rates?
No. The process that we use to determine the pricing of UnitedHealthcare reimbursement rates does not use AI.
Does UnitedHealthcare use AI to determine length of coverage?
No. UnitedHealthcare uses AI as a guide to help inform providers, families and other caregivers about what types of interventions or care a patient may need, whether in a health care facility or at home.
Does UnitedHealthcare use AI to reject medical claims?
No. We do not use, and have never used, AI to make adverse decisions related to claims.
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