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
Add me. I was denied Cervical MRI from Humana. My In-Network Orthopedic Special did full spinal Xrays prior to the requests for Cervical & Lumbar MRIs but only Lumbar was approved. Cervical involves C1-C7. Lumbar MRI showed L2 Ganglion cyst, spurs, herniated discs. I have constant pain, sciatica, muscle, neuropathy, nerve damage, spasms/contractions that have stolen my QOL. There was no lawsuit involved as damage was Domestic Violence and I divorced him. I’m on SSD and fixed income and simply cannot afford the options of ongoing PT or Chiropractic care. Daily tasks have immensely been impacted. I am still so distraught over the failure of the medical insurance system that it has created enormous depression issue, which create further challenges. More days than not, I simply cannot function mentally nor physically, as my body doesn’t possess the tolerance. Household cleaning, cooking, laundry, et-cetera are impossible to maintain, followed by many following days of bedrest recovery. And to my dismay, my
PCP & NPs have not kept accurate, detailed records of my symptoms, complaints, treatments, medications, domestic violence. I leave the doctor’s office stressed & angry bc no progress is accomplished, they are not listening bc they simply do not care. What I feel is that I receive sick care not health care. Other pursuits of PCPs were same scenarios.
So yes, please add me or contact me if you feel my best option to pursue via Civil Case versus Class Action would be recommended.
I appreciate and value your expertise and time. I honor your mission’s provided to millions of people who deserve restitution.
Respectfully,
Cynthia Martin
Add me
Please add me
My claim have denied continously. Add me to your list.
When I called, I was told that a dental procedure would be determined at the time of the procedure, even though Humana Advantage Plan provides dental coverage, but does indicate if several procedures are covered or not in any printed material or when you speak with a representative. They denied the procedure, even though my dentist indicated that the procedure was necessary to my dental and physical health. Add me to your lawsuit.
ADD my name to HUMANA list too, was in hospital whole month of April- 2023, was suppose to go to REHAB per DR’s, HUMANA denied my approval 3x, had to get something else, which cost me another week in the hospital , 75 yrs. old. TY I have since switched to UNITED health.
Debra7up@aol.com
Please add my name to this lawsuit?
I was sent to a rehab after hospital care I was there for 3 weeks , the hospital told me if they made another claim to Humana that they would deny me even though I still needed rehab, you can’t rehab someone with severe medical problems in 3 weeks
Yes I have been denied. Add me please
Please add they denied me for no reason
I have been denied partial payment on denture owing $1 thousands some dollar left owing me to pay. I’m 70 years old fixed income.