A Blue Cross Blue Shield Association study attributes $942 million in added insurer costs to more intensive care over 2024–25, compared with 2023; more frequent billing for secondary diagnoses accounted for $653 million, as providers used AI to identify them.
BCBSA said providers used AI to find secondary conditions by scanning patient records or using ambient scribes, which listen to patient conversations and draft medical notes. Secondary conditions are illnesses separate from the one being treated. The study examined inpatient billing, where more complex documented cases can command higher insurer payments.
Among people undergoing major bowel surgeries, recorded secondary diagnoses involving partial intestinal blockages rose 55%, and those involving excess acid in the body rose 33%, from Q1 2023 to Q4 2025. BCBSA said more complex diagnoses in bowel-disease surgery cases did not correspond with higher treatment rates; anemia diagnoses, for example, were not accompanied by more blood transfusions. BCBSA’s Luke Chalker said the mismatch suggested AI was finding more billable conditions, not sicker patients. Centene and other insurers have also said health systems’ AI use has led to aggressive or inappropriate reimbursement payments.
