Humana AI class action lawsuit overview:
- Who: Joanne Barrows and Susan Hagood filed a class action lawsuit against Humana Inc.
- Why: Barrows and Hagood claim Humana uses an AI model to deny care to elderly patients who have already had a real human doctor determine the care was medically necessary.
- Where: The class action lawsuit was filed in Kentucky federal court.
Health insurance company Humana unlawfully deploys artificial intelligence (AI) to wrongfully deny elderly patients care that is owed to them under Medicare Advantage plans, a new class action lawsuit alleges.
Plaintiffs Joanne Barrows and Susan Hagood claim Humana uses AI in place of human doctors to override live physicians determinations “as to medically necessary care patients require.”
The plaintiffs argue Humana is aware that predictions made by its AI model, nH Predict, are “highly inaccurate” and “not based on patients’ medical needs,” but still continues using it to deny patients’ coverage anyway.
“Despite the high rate of wrongful denials, Humana continues to systemically use this flawed AI Model to deny claims,” the Humana class action states.
The plaintiffs want to represent a nationwide class and multistate subclass of individuals who purchased a Medicare Advantage health insurance plan through Humana during the period of four years prior to the filing of the complaint through the present.
Humana allegedly aware only ‘tiny minority’ of policyholders will appeal a denied claim
The plaintiffs argue Humana is aware only a “tiny minority” of policyholders will appeal a denied claim, with the majority opting to either pay out of pocket costs or “forgo the remainder of their prescribed post-acute care.”
“Humana banks on the patients’ impaired conditions, lack of knowledge, and lack of resources to appeal the wrongful AI-powered decisions,” the Humana class action states.
Being denied care, meanwhile, causes elderly patients to get “prematurely kicked out of care facilities” and forced to choose between depleting their family savings or “forgo care altogether,” the Humana class action alleges.
Barrows and Hagood claim Humana is guilty of unjust enrichment, breach of contract and breach of the implied covenant of good faith and fair dealing, and of violating the law in multiple states.
A separate class action lawsuit was filed against Humana in February by a consumer arguing the company placed unlawful pre-recorded promotional messages to individuals who had not consented to receiving them.
Have you been denied care under Humana’s Medicare Advantage plan? Let us know in the comments.
The plaintiffs are represented by James F. Guilfoyle of Guilfoyle Law Office and Glenn A. Danas, Ryan Clarkson and Zarrina Ozari of Clarkson Law Firm PC.
The Humana AI class action lawsuit is Barrows, et al. v. Humana Inc., Case No. 3:23-cv-00654, in the U.S. District Court for the Western District of Kentucky.
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23 thoughts onHumana uses AI to deny elderly patients Medicare care, class action claims
I have Humana Medicare advantage plan.
Humana has denied several claims of mine. They have even denied prescriptions that my doctor proscribed. I’ve been denied pre-surgery testing. I’m even being charged a co-pay for my primary care physician, when there is no co-pay for primary care.
I was denied by Humana approximately ten times (appeal-after-appeal) !! What a very stressful and depressing time this was. I did have the Humana Medicare Advantage plan, but have since switched to a different provider.
How can I be a part of this lawsuit?
Humana Advantage is terrible. I was denied a prescription for pain medication that my Doctor recommended. I was also charged over $100.00 for a prescription at a Walgreens pharmacy for something that I was charged $30.00 for at a different Walgreens a month before. All while I had Humana.
I’ve been denied by Humana on multiple medical claim. First they denied multiple claims from Imaging company I had been going to from 2017- 2022 and after they reviewed 2 years of records they went back and denied most of 2021 imaging claims and then they denied a claim to a ER visit I had at In Network Hospital October 2022 and still claiming it will not be paid.
So my husband is 68 and Humana is horrible they have denied t
Claims then excepted some not many but we had to pay out of pocket at a dentist about 2months ago and they charged us 540 bucks and then had to reimburse me 120 also my husband was having dental work and the claim was submitted dec 14 but fhey didn’t getva copy of the pre determination letter till 2 days ago and now it’s going to cost More cash.,refuse to osy for his gout medicine
My father who was 66 was denied at least 5 times by humana for the much needed medical help that he needed for his recovery. They denied this important step in his recovery that resulted in my father’s death. The case managers at the hospital noticed that the Dr’s reports and the notes were never read by humana but we still received a denial all 5 times. If he would not have been
denied he probably would have lived.
Well folks a little alert for people that have Humana for Medicare , especially Humana Medicare advantage! Sue’s Dad age 87 came up from Florida via medical transport for her Moms celebration of life. Well as it turned out he needed a little medical care while he has been here! He has been in rehab for a couple of weeks and seems to be doing quite well. It was deemed medically necessary that he remain in rehab until his condition improved a bit more. Well low and behold the Humana Medicare advantage plan are denying him coverage. He appealed twice and deny, deny! The insurance company has decided that they know more than the medical professionals! I would not recommend a Humana plan to anyone. Just today I saw there is a class action law suit where they are using AI to decide peoples fate. Pretty much aimed at Medicare Advantage patients. Your health is being decided by artificial intelligence! This sure does look like breach of contract and then some. Anyway as always follow the money. The insurance company does not give a rats ass about you. The bottom line is all they care about. I am simply disgusted with Humana and Medicare Advantage! Any one that has it I would run the other way! Share if you care!
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Humana I was told for a colonoscomy I had to put down 149 dollars I have a lump in my colon and cant afford to do this also they cheated me of my dental money I hardly used the insurance and they wanted a payment. I am 76 and so fed up paying before I get a proceedure I do my co pays at the place I go and still they want another larger payment brfore the procedure which used to be preventive care? What happened? All my porocedures I had to come up with omney even to putin my pacemaker