AI didn't break health claims. Reviewing them without medical knowledge did.

In 2026, the first answer more patients hear from their insurer is a single word: denied.

I've spent years on both sides of that world — as a medical professional who advises on care, and as the person who once led health claims for an insurer. So I've watched this year's shift with more unease than most.

Denial rates are climbing past 10%, and for some plans far higher. The reason isn't that patients suddenly need less care. It's that claims are increasingly reviewed in seconds — by algorithms, or by reviewers without the medical knowledge to read them — and rejected over a missing code or keyword a clinically trained eye would have waved through. When the reviewing side moves faster than the submitting side, denials rise almost by definition.

Here is what concerns me as a medical professional: an algorithm, or a data-entry reviewer, doesn't see the patient. They see a data field. An 80-year-old with arthritis, or a cardiac patient sent for a routine test, becomes just another pattern to match or reject.

Speed is not the same as judgment.

And here's the part few talk about: fewer than one in a hundred people ever challenge a denial — yet a large share of appeals succeed. That gap is where real harm quietly lives.

I'm not against AI, or against the people who process claims. Used well, AI catches genuine errors and good operators speed honest payments. But claims decisions belong behind human clinical judgment, not in front of it. The right question isn't “how fast can we decide?” It's “who is accountable when the decision is wrong?”

If you work in insurance or medicine: keep a clinically informed human in the loop where it counts. And if you're a patient who has been denied — appeal. Through the ombudsman, through your broker, through your HR for a corporate policy, or directly to your insurer. The odds are better than you think.

Has AI — and claims handling without medical knowledge — made things fairer in your experience, or just faster?