Impact of Artificial Intelligence in Health Insurance Industry
(Photo : Impact of Artificial Intelligence in Health Insurance Industry)

With the continuous advent of technology usage, numerous innovations are being developed and used to improve society's quality of life. Artificial intelligence is one of these innovations, and now it is being applied in health insurance, a critical and incredibly important component of today's healthcare industry.

Artificial intelligence has numerous impacts in the health insurance industry to date, and these impacts may be separated into two types - the benefits it has brought, and the drawbacks it inevitably has. Read on to know more.

Artificial Intelligence Benefits

1. Reliable identifications of claims

Doing manual verification of claims is incredibly tedious work, with average, mid-sized insurers receiving about 700,000 claims from hospitals every year. With a pandemic still in our midst, the number of claims will inevitably boom. Identifying which claims could be approved could take hundreds of employees and even more time, which would slow the process.

Studies have shown that one in ten claims are incorrect - and must be looked at in closer detail by administrative staff. Claim information and any existing and available patient data must be manually dissected by then, in order to aid decisions whether intervention is needed or not.

Approaches made by artificial intelligence are designed to sift through all of these claims, singling out those who have increased likelihood of intervention. It filters out claims that need further review by human staff, significantly reducing insurer workload.

Artificial intelligence also has the ability to turn down fraudulent claims, as researchers are continuously developing AI algorithms to effectively detect cases of fraud.

2. Faster analysis of data

Data analytics is an important part of the health insurance industry, as raw data may bring important insights that will help insurers garner information that will lead them to a better understanding of consumer behavior. 

Like what was mentioned earlier, manual sifting through information by human employees is extremely tedious and takes too much time, and AI will immensely help streamline the process of data analysis.

Another benefit of AI having the ability to analyze data is that it can also do predictive analytics, which detects patient behavior such as visiting a specialist more often than they usually do. This helps insurers reach out early and do preemptive care, as early detection of impending negative health events has already been done by AI.

3. Provides customization of plans

Armed with the necessary data it needs to make calculated decisions, artificial intelligence makes use of the patient's profile to understand their needs better - which gives them the ability to provide a customized plan that suits the patient's requirements and has competitive pricing.

Aside from the automatic suggestions that artificial intelligence may give, patients still have free rein on which plan they choose to purchase. Patients based around The Sunshine State may consider getting Florida Blue plans compared with other insurance carriers, as they offer competitive rates and are accessible in almost every country in the state. These are very cost-effective, and there are a variety of options!

Patients can also freely decide the duration of the plan they choose to get, as artificial intelligence will only suggest what it thinks is best for you based on your profile. Patients who choose to get short term plans and are based in Florida are in luck. They run quite cheap and finances can be arranged easily.

4. Quality customer experience

Patients who are in immediate need of assistance or have an urgent query do not need to wait for long, as chatbots developed with artificial intelligence are available 24/7 to suit their needs. As chatbots have been proven to be quite effective, it has been said that they will be the primary touchpoint for health insurance customers by 2030!

A survey made by Accenture states that 68% of health insurers have already adopted the usage of chatbots, drawing the conclusion that chatbots have helped improve customer service due to their retention. 

5. Cuts down costs 

Artificial intelligence automates administrative processes, saving time and most importantly, money! When tedious routine tasks are automated by AI, as much as $7 billion can be saved by health insurers in as short as 18 months, due to the fact that this reduces the tasks of full-time employees. The time spent doing these tasks can be devoted to those of higher importance, thus saving precious time and money.

Not only do insurers save money, but also the patients. AI can recommend preventative healthy habits such as exercise and nutrition strategies, cutting expenses that may be caused by unhealthy habits.

Well, when in need of an agent for more information, there's no need to look far and wide. To make things clear, FBC HealthPlans Agents are just around the corner and can be contacted easily. Agents can provide further assistance apart from what artificial intelligence may give.

Artificial Intelligence Drawbacks

1. Presence of data privacy and security challenges

For artificial intelligence algorithms to work, it needs access to a large pool of data and information. However, will insurers be able to safeguard the data every patient has?

The storage of massive datasets in one single location by insurers may attract hackers, who aim to use these data in criminal acts. Now, data privacy and security challenges are posed on the shoulders of insurers, as they are responsible for securing this data.

Because of this, many organizations keep data assets guarded in a highly secure system, most often one that is Health Insurance Portability and Accountability Act (HIPAA) compliant. HIPAA compliance enforces privacy and security for highly sensitive patient data and information.

2. Ethical issues

The algorithms that artificial intelligence uses for it to work is highly complicated, and the average human may find it increasingly difficult to decipher how AI makes its own decisions. Free of any emotions and personal opinions that affect humans, it can be safely concluded that artificial intelligence does not possess any kind of bias. However, there's no knowing if the data the AI uses heavily leans on one perspective rather than another.

While questions regarding ethics in the use of artificial intelligence may be more philosophical than legal, it is still important to consider as AI might make life-altering decisions that have the possibility to cause harm.

It can be said that to date, while AI is clearly a breakthrough and an important innovation, it is still immature in certain areas where decisions must be made by something or someone with more empathy.  

Drawbacks are inevitable for any breakthrough and innovation, and artificial intelligence is not immune to this, especially AI used in health insurance. However, it is safe to say that the benefits outweigh its drawbacks, as it saves myriad time and cuts down costs. Aside from that, its impact can bring customer satisfaction, as the slow pace of traditional customer service is now being replaced by 24/7 chatbots. With technology such as AI, increased quality of life can be experienced by society in many sectors - including healthcare.

ⓒ 2021 All rights reserved. Do not reproduce without permission.