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Explore 95% Reversed: Congress Probes AI Care Denials with 555 views, 14 likes, and 1 comments. Experience the impact of this video content that has captured audience attention.

Medicare Advantage plans overturned 95% of appealed skilled-nursing admission denials in a federal review. But only 18% of denied requests were appealed. This investigation examines the documented reversal pattern at UnitedHealth Group, CVS Health, Humana, and UnitedHealth's naviHealth subsidiary—and the separate, unresolved question Congress is now asking: how did algorithms, predictive tools, contractors, and human reviewers influence the original decisions? Important: the HHS Inspector General did not conclude that AI caused the denials. The appeal results are established findings; the role of AI is the subject of congressional records requests. CHAPTERS 00:00 Ninety-five percent reversed 00:49 What the government measured 01:53 The 18% appeal gap 03:04 UnitedHealth, CVS, and Humana 04:34 What role did the systems play? 06:12 The burden on families 07:15 The rule, the incentive, and the caveat 08:39 Congress demands the records 09:30 What seniors—and the public—can do PRIMARY SOURCES HHS OIG skilled-nursing review: https://oig.hhs.gov/reports/all/2026/medicare-advantage-organizations-overturned-nearly-all-appealed-prior-authorization-denials-for-skilled-nursing-facility-admission-raising-concerns-about-initial-denials/ HHS OIG full SNF report: https://oig.hhs.gov/documents/audit/11694/OEI-09-24-00331.pdf HHS OIG rehabilitation/LTCH report: https://oig.hhs.gov/documents/audit/11693/OEI-09-24-00330.pdf Senate July 2026 records requests: https://www.blumenthal.senate.gov/newsroom/press/release/blumenthal-and-hawley-press-medicare-advantage-insurers-about-refusal-of-care-for-vulnerable-seniors Senate 2024 investigation summary: https://www.blumenthal.senate.gov/newsroom/press/release/senate-permanent-subcommittee-on-investigations-releases-majority-staff-report-exposing-medicare-advantage-insurers-refusal-of-care-for-vulnerable-seniors CMS algorithm and coverage FAQ: https://www.cms.gov/files/document/hpms-memo-faq-coverage-criteria-and-utilization-management-cms-4201-f-02-6-2024-pdf.pdf This video is reporting and general information, not medical or legal advice. If a delay in care could jeopardize health, ask the plan and treating clinician about expedited appeal rights. #AI #MedicareAdvantage #Healthcare

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