Consumers Need an AI Defender Tool. Can AI really help improve healthcare efficiency?
A Little Background on UnitedHealth Group, Inc. (UNH)
It’s been both bitter and educational watching what’s happening to what was once the biggest company in U.S. healthcare. UnitedHealth Group (UNH) is failing its consumers, members, and patients—while also destroying hundreds of billions in shareholder value.
UNH was built through acquisitions and strategic focus, becoming the most diversified healthcare company in U.S. history. If you look at their long-term stock chart (especially around the Affordable Care Act of 2010), you’ll see exactly what I mean. The company grew significantly by aligning itself with the ACA—officially known as The Patient Protection and Affordable Care Act, signed by President Obama on March 23, 2010.
Take a look at the historical chart from May 15, 2025, on CNBC. If you go back to 2010, you’ll see the growth I’m talking about. Over the years, UNH expanded into Pharmacy Benefits Management (PBM), Medical Groups, Outpatient Surgery Centers, and even tech platforms like Change Healthcare.
As a former practice administrator, I can tell you: what really made UNH “print money” is that they became the largest employer of physicians in the U.S. That gave them major control over care delivery and cost management.
My research shows UNH has made more than 25 large, significant acquisitions—but also reportedly hundreds more that were deemed “immaterial” based on their size. For a company as massive as UNH, even a $1 billion acquisition might not be considered material under accounting rules.
UNH has also been accused of shifting profits between subsidiaries to meet minimum medical benefit requirements. In other words, profits could be left within provider subsidiaries while the insurance side still meets state and federal regulations. It’s legal—but it’s starting to raise red flags with regulators and lawmakers.
Controlling Medical Costs with AI?
STAT News recently ran a piece titled “UnitedHealth said it was too dangerous for him to be discharged. Days later, it denied his care.” It highlights a growing issue:
“Algorithms are still driving denials of care by insurers,” said Christine Huberty, an attorney at the Center for Medicare Advocacy.
STAT’s investigation found that UnitedHealth—after acquiring NaviHealth in 2020—used algorithms to predict how long patients should stay in care facilities, then cut off coverage after that predicted time. UNH phased out the NaviHealth brand in 2024, but the use of these algorithms continues, according to Huberty, who spoke at the STAT Summit in San Francisco.
AI Is Playing a Bigger Role in Denials of Care
Today, it’s hard to blame insurance companies or third-party administrators (TPAs)—and I’ve owned or helped operate both—for using AI. The real issue is how they’re using it.
We’re now in a high-speed environment where innovation takes months, not years. Unfortunately, consumers are completely outgunned. Healthcare is now in an AI arms race, and it’s overwhelming both patients and providers who are trying to get people the care they need.
Here’s a stat that should stop you in your tracks: in 2024, there were 850 million claims or prior authorizations denied. That’s massive. And while I don’t gamble, I’d bet that Optum, UNH’s own care provider subsidiary, has a very low denial rate. Why? Because when the insurer owns the provider, there’s less need for internal denials.
What Consumers Need Now
Healthcare is a $5.3 trillion industry. Costs keep rising. Complexity keeps growing. And consumers? They’re stuck with almost no tools to fight back.
That needs to change.
Now is the time for consumers to start using AI for their own benefit—starting with:
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Aggregating and organizing their medical records
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Understanding treatment history and drug interactions
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Using AI to help file appeals for denied claims
This is the kind of AI we need—not more automation for insurers to say “no,” but tools that empower consumers to say “yes” to their care.
Denials aren’t going away. If anything, they’re going to increase. But with the right tools, patients can finally push back.
Time to Flip the Script
Healthcare shouldn’t just be about who has the most data and the fastest algorithm. Right now, insurers are using AI to protect their bottom line. It’s time consumers used AI to protect their health, and we’re developing solutions to do just that!
About HealthScoreAI ™
Healthcare is at a tipping point, and HealthScoreAI (HSAI) is positioning to revolutionize the industry by giving Consumers control over their health data and unlocking its immense value. U.S. healthcare annual spending has exceeded $5 trillion with little improvement in outcomes. Despite advances, technology has failed to reduce costs or improve care. Meanwhile, 3,000 exabytes of Consumer health data remain trapped in fragmented USA system of 500 EHRs, leaving Consumers and doctors without a complete picture of care.
HealthScoreAI seeks to provide a unique solution, acting as a data surrogate for Consumers and offering an unbiased holistic view of their health. With over 850 million medical claims denied annually in the U.S., HSAI intends on giving Consumers practical tools to respond to denial of care by insurers. We aim to bridge the gaps in healthcare access and outcomes. By monetizing de-identified data, HealthScoreAI seeks to share revenue with Consumers, potentially creating a new $100 billion market value opportunity. With near-universal EHR adoption in the USA, and advances in technology, now is the perfect time to capitalize on the data available, practical use of AI and the empowering of Consumers, in particular the 13,000 tech savvy baby boomers turning 65 every single day and entering the Medicare system for the first time. Our team, with deep healthcare and tech expertise, holds U.S. patents and a proven track record of scaling companies and leading them to IPO.
Noel J. Guillama-Alvarez
https://www.linkedin.com/in/nguillama/
+1-561-904-9477, Ext 355
https://www.statnews.com/2025/05/19/unitedhealth-algorithm-ai-denials-of-care/
https://www2.deloitte.com/us/en/insights/multimedia/podcasts/ai-to-improve-health-care-access.html