Hospitals and Insurers Are Using AI Against You (A Doctor Explains)

Hospitals are using AI to bill for a sicker version of you. Insurance companies are using AI to deny the bill. As a physician who has worked inside the hospital system, I break down how artificial intelligence is driving up medical billing (what critics call upcoding), claim denials, and health insurance premiums, and why the patient ends up paying for both sides. None of this is illegal. That's the problem. Congress and federal agencies wrote the rules that decide how hospitals, doctors, and insurers get paid, and AI now lets large health systems and insurance companies squeeze every dollar out of them. What I cover: The documentation "query": how hospitals ask doctors to change their notes for higher billing How hospitals actually get paid (DRGs) and how doctors get paid, explained simply Why "heart failure" vs. "acute on chronic systolic heart failure" can change a hospital bill How AI coding software and AI scribes are pushing billing levels up, in the hospital and in the clinic What Blue Cross Blue Shield found: more complex coding, no change in care, nearly $1 billion in extra costs How insurers use AI to deny claims and downgrade visits: Cigna, Aetna, and the UnitedHealth nH Predict lawsuit Medicare's new WISeR program, where AI reviews prior authorizations and vendors share in the savings from denials Medicare Advantage overpayments and coding, and how they raise Part B premiums for every senior Exactly how you pay: employer health insurance, deductibles, coinsurance, premiums, traditional Medicare, and Medicare Advantage The laws and policies that built this system, from Medicare in 1965 to today What could fix it: site-neutral payment, the No UPCODE Act, banning denial incentives, and physician review of AI denials What you can do: itemized bills, facility fees, and why you should appeal denials Why this is a system problem, not a bad-people problem: incentives, behavior, and the neuroscience of reward ━━━━━━━━━━ Read the full article with sources on my Substack: https://substack.com/@nicomunley/p-21... ━━━━━━━━━━ DISCLOSURE: I run a cash-based practice and don't bill insurance, so I benefit when people question this system. This video does not accuse any company of fraud. Educational content only; not medical, legal, or financial advice. Nico Munley, DO · Internal Medicine · Prevention & Personalized Primary Care munleymedical.com #HealthcareAI #MedicalBilling #HealthInsurance #MedicareAdvantage #HealthcarePolicy