The Blue Cross Blue Shield Association says hospitals’ AI coding was the biggest factor in nearly $1 billion in added spending for its insurers over two years, costs it says feed into higher premiums; its analysis found no evidence patients received more care.
The association analyzed claims from 2023 to 2025. It says AI billing software scans medical records and lab data for codeable details; secondary diagnoses such as low sodium or anemia can move claims into higher-paying categories.
KFF’s analysis put the median proposed premium increase for 2027 at 15%, likely a second consecutive year of double-digit hikes; this year’s median increase was 20%. Separately, CMS’s WISeR pilot uses AI to review prior-authorization requests for selected services in traditional Medicare, including epidural steroid injections and treatments for spinal stenosis and knee osteoarthritis. CMS records cited in a lawsuit and earlier reporting show continued delays and denials under the model.
