Since its inception, the insurance industry has thrived on risk assessment and precise event likelihood estimation. This perpetual cycle involves insurers and customers collaborating to predict and safeguard against risks, underpinned by mutual trust. As the industry embraces the digital era, Artificial Intelligence (AI) emerges as a powerful differentiator. AI’s ability to analyze vast datasets and automate processes offers substantial advantages, including cost savings and enhanced decision-making

In a recent interview on CNBC’s ‘The Exchange,’ Mike Desjadon, the CEO of Anomaly Insights, shared insights into how his company is leveraging AI to alleviate the frustrations many patients face when dealing with insurance claims and billing.

Desjadon explained that a significant challenge in the healthcare industry is the vast number of coding combinations that providers must use to ensure claims are processed correctly.

“The fundamental thing we found,” he said, “there were 540 million different combinations of codes that your provider needs to bill appropriately to get you paid your explanations on point.”

AI’s role, according to Desjadon, is to bring transparency to the process by analyzing the data from both providers and insurance companies, ensuring that claims are handled correctly from the outset.

“What we do with artificial intelligence is we take in all of the data your provider is sending out and all the data your insurance company is sending back to construct transparently what should transpire with that claim, so you, as the patient, get the care you need and a clear explanation of what should happen ideally, not get a bill in the mail if all goes her properly,” he explained.

Desjadon acknowledged that insurance companies are also utilizing AI, but he hopes for a future where providers and payers collaborate using these technologies to achieve transparency.

“In the future, I hope to partner with them and providers and payers can go together on transparency using these technologies,” said Desjadon.

Addressing concerns about insurance companies potentially using AI to deny claims, Desjadon stated: “I cannot speak to the motivation, but I can speak to the complication of getting it done. For an individual to fight Humana is a daunting task.”

Ultimately, Desjadon envisions AI as a tool to simplify the healthcare insurance process, reducing administrative costs and ensuring patients receive the care they need without the hassle of denied claims or unexpected bills.

Featured image: Credit: Bluesky Insurance Company