15Health systemsBelow the top 20
Insurance denial at model speed
CapabilityDomain knowledgeImpact domainBoth
Statement (NASA form)
Given that payers already use models to review and deny claims, there is a possibility of a correlated wave of wrongful denials that no appeals team can catch resulting in care delayed or refused by a system with no duty to the patient.
Likelihood
4Likely
Consequence
3Major
Urgency
3Priority
The doctor still writes the note. The model writes the no.
Composite 15 = 4×3 + 3
Applicable mitigations
Controls · Hard fences on diagnosis, dosing, and triage language · Grounded, dated medical sources with uncertainty on the surface · Regulate high-stakes health modes as medical devices · Pace rules: no irreversible action faster than a human can reconstruct it · A real off-ramp that still functions · Contract-first delegation with privilege attenuation · Duty of care on high-stakes delegates