ALI: TONIGHT ON "PBS NEWS WEEKEND," ONE OF PRESIDENT TRUMP'S STAUNCHEST DEFENDERS AND MAGA ALLY, MARJORIE TAYLOR GREEN, PLANS TO QUIT CONGRESS IN THE WAKE OF A BITTER PUBLIC FEUD.

THEN, DEADLY STRIKES CONTINUE ALONG THE ISRAEL-LEBANON BORDER DESPITE A CEASEFIRE THAT'S BEEN IN EFFECT FOR NEARLY A YEAR.

AND HOW PATIENTS ARE USING ARTIFICIAL INTELLIGENCE TO FIGHT BACK WHEN THEIR INSURANCE CLAIM IS DENIED.

OLIVIA: THE SYSTEM ASKS FOR ALL THE DOCUMENTATION YOU HAVE THAT MAY BE HELPFUL, AND YOU PAY LIKE A 40 OR 50 DOLLAR FEE, AND THE AI CREATES A CLAIMS APPEAL FOR YOU THAT YOU CAN SUBMIT TO YOUR INSURER.

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♪ ALI: GOOD EVENING.

I'M ALI ROGIN, JOHN YANG IS AWAY.

TONIGHT, SHOCKWAVES IN WASHINGTON AFTER GEORGIA REPUBLICAN MARJORIE TAYLOR GREENE, ONCE ONE OF PRESIDENT TRUMP'S STAUNCHEST DEFENDERS, SAID SHE'S RESIGNING FROM CONGRESS IN JANUARY BEFORE HER TERM IS UP.

GREENE MADE THE SURPRISE ANNOUNCEMENT IN A VIDEO SHE POSTED ON X FRIDAY NIGHT, MARKING A DRAMATIC BREAK WITH PRESIDENT DONALD TRUMP.

IT CAME AFTER A PUBLIC FALLING OUT WITH HIM IN RECENT MONTHS, AS GREENE CRITICIZED THE PRESIDENT ON FOREIGN POLICY, HEALTH CARE AND HIS STANCE ON RELEASING FILES RELATING TO THE JEFFREY EPSTEIN CASE.

>> STANDING UP FOR AMERICAN WOMEN WHO WERE RAPED AT 14 YEARS OLD, TRAFFICKED AND USED BY RICH POWERFUL MEN SHOULD NOT RESULT IN ME BEING CALLED A TRAITOR AND THREATENED BY THE PRESIDENT OF THE UNITED STATES, WHOM I FOUGHT FOR.

ALI: TRUMP FIRED BACK ON TRUTH SOCIAL TODAY, ONCE AGAIN CALLING GREENE "A TRAITOR" WHO "WENT BAD."

TIA MITCHELL IS THE WASHINGTON BUREAU CHIEF FOR THE ATLANTA JOURNAL-CONSTITUTION.

SHE'S COVERED GREENE SINCE HER FIRST CAMPAIGN IN 2021.

THANK YOU SO MUCH FOR JOINING ME.

MARJORIE TAYLOR GREENE, UP UNTIL THIS FALLING OUT, WAS ONE OF PRESIDENT TRUMP'S STAUNCHEST DEFENDERS.

WHAT DO YOU ATTRIBUTE HER ABRUPT RESIGNATION?

TIA: I THINK IT HAS BEEN BUILDING.

THERE HAS BEEN A SPLIT IN THE REPUBLICAN PARTY AROUND FAR RIGHT REPUBLICANS SINCE HIS SECOND ADMINISTRATION BECAUSE THEY FELT HE WAS NOT NECESSARILY LIVING UP TO HIS CAMPAIGN PROMISES.

OF COURSE, MARJORIE TAYLOR GREENE STARTED SPEAKING OUT ABOUT IT EARLIER THIS SUMMER ON THINGS LIKE ISRAEL AND THE WAR WITH GAZA AND OTHER FOREIGN POLICY, SOME LEGISLATION THAT THE WHITE HOUSE WANTED CONGRESS TO PASS THAT SHE FELT DIDN'T ADHERE TO THE AMERICA FIRST MAGA BRAND, BUT THINGS REALLY CAME TO A HEAD WHEN IT CAME TO RELEASING THE EPSTEIN FILES, MARJORIE TAYLOR GREENE WAS ONE OF THE 4 REPUBLICANS WHO, ALONG WITH DEMOCRATS, FORCED A VOTE ON THE EPSTEIN FILES OVER TRUMP'S OBJECTIONS INITIALLY, AND THAT WAS REALLY WHAT SENT TRUMP OVER THE EDGE.

HE SPLIT WITH HER.

HE UNENDORSED HER, WAS VERY CRITICAL OF HER IN PERSONAL TERMS, AND I THINK MARJORIE TAYLOR, AND THIS HAPPENED ABOUT A WEEK AGO, AND MARJORIE TAYLOR GREENE STARTED DOING SOME SOUL SEARCHING BECAUSE SHE REALLY CAME TO CONGRESS TO WORK ALONGSIDE TRUMP.

SHE SAID SHE WAS THAT WAS PART OF HER AGENDA WAS TO HELP HIM CARRY OUT HIS, AND I THINK ONCE SHE CAME TO THE CONCLUSION THAT, YOU KNOW, SHE COULDN'T WORK WITH TRUMP, THEY ARE NOT ON THE SAME SIDE, SHE KIND OF LOST INTEREST IN REMAINING A MEMBER OF CONGRESS.

ALI: PRESIDENT TRUMP TODAY TOLD REPORTERS THAT SHE RESIGNED BECAUSE HE WITHDREW HIS SUPPORT, AND HE SAID THAT IF SHE HAD RUN FOR RE-ELECTION, SHE WOULD HAVE LOST.

IS THAT AN ACCURATE INTERPRETATION OF PRESIDENT TRUMP'S INFLUENCE OVER REPUBLICAN CANDIDATES IN THIS CASE, DO YOU THINK?

TIA: WELL, YES I KNOW.

I FEEL THAT MARJORIE TAYLOR GREENE WOULD HAVE LIKELY FACED WHAT THOMAS MASSIE HAS FACED, WHICH MEANS THAT TRUMP WOULD RECRUIT PEOPLE TO CHALLENGE HER IN A PRIMARY, THERE WOULD BE A LOT OF MONEY SPENT AND IT WOULD BE A BITTER PRIMARY CAMPAIGN, BUT LIKE THOMAS MASSEY, I STILL THINK MARJORIE TAYLOR GREENE WOULD BE CONSIDERED THE FRONT RUNNER AND WAS LIKELY TO WIN REELECTION.

SO THE CALCULATION FROM MARJORIE TAYLOR GREENE WAS, DO I WANT TO BE, YOU KNOW, HAVE THIS TOUGH REELECTION BID AND BE DRUG INTO A NASTY PRIMARY BATTLE HAVE DONALD TRUMP REALLY TRYING TO TURN MY CONSTITUENTS AGAINST ME, AND I COULD COME OUT VICTORIOUS, ENTER CONGRESS FOR ANOTHER TERM, AND THEN TRUMP IS GOING TO EXPECT ME TO DEFEND HIM AND DEFEND HIS POLICIES.

I DON'T WANT TO STAND UP FOR THAT.

ALI: SHE'S ALSO CITED THE FACT THAT SHE'S BEEN GETTING CALLS FROM SECURITY FIRMS, GIVEN THE AMOUNT OF OF VITRIOL THAT SHE HAS BEEN ON THE RECEIVING END OF SHE IS A PUBLIC FIGURE, CERTAINLY, SHE IS NO STRANGER TO CRITICISM, BUT DO YOU THINK ALSO THAT THE RHETORIC AGAINST HER AND THE THREATS SHE MAY HAVE FACED COULD HAVE ALSO PLAYED A ROLE HERE IN THIS DECISION?

TIA: I DO.

I THINK, AGAIN, IF YOU LISTEN TO THE VIDEO SHE POSTED, SHE BASICALLY SAID SHE DIDN'T FEEL LIKE THE RECENT VITRIOL AND THREATS WHICH CAME BECAUSE TRUMP'S CRITICISM, THAT TO HER HURT EVEN MORE BECAUSE IT WAS FROM AGAIN SOMEONE THAT WASN'T JUST SOMEONE SHE CONSIDERED A FRIEND AND AN ALLY, SO IF HE'S TURNED ON ME AND HE'S, YOU KNOW, LEADING TO ALL THIS CRITICISM AND VITRIOL AND THREATS, IT IS NOT WORTH IT TO ME AND MY FAMILY.

WE KNOW THAT, YOU KNOW, PART OF HER CORE VALUES IS BEING A MOM, PUTTING FAMILY FIRST, AND SO I THINK FOR HER SHE BEGAN TO WONDER, WHY AM I ENDURING ALL OF THIS?

ALI: WHAT DO YOU THINK IS GOING TO BE NEXT FOR HER?

TIA: SO, YOU PRESIDENT TODAY, AFTER HE ALLEGEDLY TRIED TO ESCAPE HOUSE ARREST DAYS BEFORE BEGINNING A 27-YEAR PRISON SENTENCE.

THE SUPREME COURT JUSTICE WHO OVERSAW THE CASE AGAINST JAIR BOLSONARO SAID THE FAR RIGHT LEADER HATCHED A PLAN WITH HIS SON TO FLEE HIS HOME FOR THE U.S.

EMBASSY IN BRAZIL TO SEEK POLITICAL ASYLUM.

BOLSONARO IS A POLITICAL ALLY OF PRESIDENT TRUMP.

HE'S NOW EXPECTED TO REMAIN IN CUSTODY UNTIL BRAZIL'S SUPREME COURT PANEL HEARS THE CASE ON MONDAY.

DEEMED A FLIGHT RISK, BOLSONARO HAD BEEN PLACED ON HOUSE ARREST AHEAD OF HIS PRISON TERM AFTER HE WAS FOUND GUILTY OF CHARGES FOR LEADING A COUP ATTEMPT.

ISRAEL LAUNCHED SEVERAL AIRSTRIKES INTO GAZA OVERNIGHT DESPITE THE ONGOING, YET FRAGILE, CEASEFIRE IN THE REGION.

THE ISRAELI MILITARY SAID THE STRIKES WERE IN RESPONSE TO AN ATTACK FROM AN ARMED MILITANT WHO CROSSED INTO AN AREA THE IDF CONTROLS AND OPENED FIRE.

NO ISRAELI SOLDIERS WERE INJURED, BUT ISRAEL SAID IT RESPONDED WITH STRIKES ACROSS THE GAZA STRIP MEANT TO TARGET HAMAS MILITANTS HEALTH OFFICIALS IN GAZA SAID AT LEAST 24 PEOPLE WERE KILLED AND NEARLY 60 WOUNDED, INCLUDING CHILDREN.

CLASSROOMS ACROSS PART OF NIGERIA ARE NOW CLOSED OVER SECURITY CONCERNS FOLLOWING MASS KIDNAPPINGS AT SCHOOLS IN THE COUNTRY THIS WEEK.

NEW NUMBERS OUT TODAY REVEAL GUNMEN TOOK MORE THAN 300 STUDENTS AND 12 TEACHERS FROM A CATHOLIC SCHOOL ON FRIDAY.

CRITICS CALLED THE AGREEMENT INADEQUATE AND QUESTIONED WHETHER IT WOULD HELP LOWER THE PLANET'S RISING TEMPERATURE.

STILL TO COME ON "PBS NEWS WEEKEND," STRIKES CONTINUE TO CLAIM LIVES AS THE CEASEFIRE BETWEEN ISRAEL AND HEZBOLLAH REACHES THE ONE YEAR MARK.

AND, HOW INSURANCE COMPANIES AND PATIENTS ARE USING AI FOR DISPUTED CLAIMS.

>> THIS IS "PBS NEWS WEEKEND," FROM DAVID M. RUBENSTEIN STUDIOS IN WASHINGTON, HOME OF THE PBS NEWSHOUR, WEEKNIGHTS ON PBS.

ALI: NEXT WEEK MARKS ONE YEAR SINCE THE CEASEFIRE THAT ENDED THE ISRAEL-HEZBOLLAH WAR IN LEBANON.

DURING THAT TIME, FIGHTING ON THE GROUND HAS CONTINUED.

JUST THIS WEEK, ISRAEL LAUNCHED A SERIES OF STRIKES IN SOUTHERN LEBANON THAT KILLED AT LEAST A DOZEN PEOPLE.

THE ISRAELI MILITARY SAID IT WAS TARGETING HEZBOLLAH MEMBERS.

SPECIAL CORRESPONDENT LEILA MOLANA ALLEN.

AS HEALTH INSURERS INCREASINGLY RELY ON ARTIFICIAL INTELLIGENCE >> ON TUESDAY EVENING, IT WAS STRUCK BY THREE ISRAELIS.

13 PEOPLE DIED IN THE STRIKE.

IT WAS AT THE HAMAS TRAINING COMPOUND.

RESIDENTS SAY AND MORE THAN 4000 LEBANESE WERE KILLED BY ERIC -- ISRAEL'S GROUND INVASION.

MANY THOUSANDS MORE STILL BEAR ITS CARS,.

SHE SHOULD HAVE BEEN SAFE IN HER HOME.

INSTEAD, IT NEARLY KILLED HER.

LATE LAST YEAR, AND THEY PACKED UP, PREPARING TO FLEE THEIR VILLAGE.

THEY LEFT IT MOMENTS TOO LATE.

A MISSILE HOOD, TEARING THE WORLD APART.

HIS BABY DAUGHTER, JUST ONE YEARS OLD, TRY TO SHELTER HER BODY FROM THE BLAST BUT IT WAS NOT ENOUGH.

>> EVERYTHING WAS EXPLODING AROUND ME.

THERE WAS SHRAPNEL EVERYWHERE, AND THE ROOF WAS FALLING APART, BUT I KEPT HOLDING HER.

>> HER MOTHER SAVED HER SEVEN-YEAR-OLD SISTER BY THROWING HER ON THE BALCONY AND HER HOME WAS ENGULFED BY FLAMES.

>> IS INCREDIBLY HARD TO SEE HER DAUGHTER BURNT IN YOUR ARMS.

SHE HAD NO EYELASHES.

>> SHE WAS RUSHED TO THE HOSPITAL, BUT SEEING HER TINY, BLACKENED BODY, SHE COULD NOT BELIEVE SHE WAS ALIVE.

>> I RAN INTO THE HOSPITAL, ASKING ABOUT MY DAUGHTER AND I HAD TO CHECK IF SHE WAS MINE OR NOT.

SHE DID NOT LOOK LIKE HER AT ALL.

BUT AS I WAS LEAVING, SHE CRIED.

I HEARD HER VOICE IN MY VOICE AND SHE SAID, YES, IT IS HER.

I HAD GOOSEBUMPS ALL OVER MY BODY.

>> NEARLY HALF HER BODY WAS COVERED IN THIRD DEGREE BURNS.

SHE SPENT MONTHS IN AND OUT OF THE HOSPITAL AND DURING PAINFUL SURGERIES.

>> THEY SUFFERED SO MUCH AND SO DID WE.

THEY WERE MOANING IN PAIN CONSTANTLY.

TODAY, SHE IS ALIVE AND FULL OF CURIOSITY.

HER FAVORITE GAMES ARE PLAYING MAKEOVER AND PAINTING ELSE.

AND SHE NEEDS MANY MORE SURGERIES AND SHE WAS DISPLACED WITH NO INCOME AND EVEN IN RELATIVE SAFETY HERE IN BEIRUT, IT FOLLOWS THEM.

>> THEY SCREAM AND KEEP COMING TO ME.

THEY HAVE NOT FORGOTTEN WHAT THEY HAVE BEEN THROUGH.

>> THE WAR IS NOT OVER FOR THOSE WHO LIVED THROUGH IT, AND FOR MANY, THE DANGER IS STILL REAL.

>> A CEASE-FIRE DEAL WAS SIGNED LATE LAST YEAR.

MORE THAN 100 LEBANESE CIVILIANS HAVE BEEN KILLED SINCE THE OFFICIAL END OF THE WAR.

MANY HEARSAY THE IDEA THAT THEY ARE SAFE IS SIMPLY AN ILLUSION.

>> DOOR DISPLACED AT LEAST 1.2 MILLION PEOPLE, A QUARTER OF THE POPULATION -- THE WAR DISPLACED AT LEAST 1.2 MILLION PEOPLE, QUARTER OF THE POPULATION.

WE ARE HERE ON THE EDGE OF BEIRUT.

WE HAVE BEEN HIT BY AIRSTRIKES OF ALL HOURS OF THE DAY.

YOU CAN SEE THE BUILDING BEHIND ME THAT HAS JUST BEEN HIT.

THE OTHER IS DIRECTLY BEHIND ME AND STARTED TO CATCH FIRE NOW.

THERE WERE TENS OF THOUSANDS OF PEOPLE THERE.

>> DISPLACED FAMILIES WERE PACKED INTO PLACES LIKE THESE.

AND THEY WERE THE LUCKY ONES.

INCLUDING CHILDREN ON THE STREET.

>> IT WAS SHORTLY AFTER THEY FLED AFTER A CEASE-FIRE.

THEY CAME BACK AND FOUND THE DAMAGE, BUT STILL FINDING AN APARTMENT TO RENT, WHICH DESTROYED THE NEIGHBORHOOD AND PRICES HAVE NOW MORE THAN DOUBLED.

>> THEY DON'T HAVE ANY RUNNING WATER AFTER AN AIRSTRIKE DESTROYED THE LOCAL WATER AREA AND DESTROYED ELECTRICITY.

>> THESE ARE THE RUINS OF HER FORMER HOME.

THEY USED TO USE THE BALCONY DAILY.

>> THIS WAR HAS TAKEN SO MANY MEMORIES FROM US.

I CRIED A LOT WHEN I REMEMBER.

IT IS MY HOME, MY PAST.

IT IS AGONY FOR ME TO LOSE EVERYTHING.

>> SURROUNDED BY THE ECHOES OF WAR, HEALING COMES WITH PAIN, AND WITH THE BOMBING ONGOING, THE CEASE-FIRE IS A LITTLE MORE THAN EMPTY.

>> I'M ALWAYS PREPARED.

I HAVE AN EMERGENCY BAG JUST IN CASE I HAVE TO FLEE AT ANY TIME.

EVEN AFTER THE CEASE-FIRE, THEY TARGETED OF FAMILY NEARBY AND WHEN WE HEARD THE SOUND, WE THOUGHT IT WAS OUR HOUSE.

THEY ARE ALWAYS IN CONSTANT STRESS YEAR, KNOWING WE COULD DIE ANY MINUTE.

>> 7.5 AIRSPACE VIOLATIONS, INCLUDING GROUND VIOLATIONS.

AND THAT IS AN AVERAGE OF 27 VIOLATIONS.

>> DURING THE WAR, IT WAS COMPLETELY DIVERTED.

LAST YEAR, WE MET THIS MAN WHO WAS IN AN AIRSTRIKE.

SOMETIMES THERE WILL BE WARNING SENT OUT ABOUT AREAS THEY ARE ABOUT TO HIT BUT NOT THIS TIME.

THE STRIKE ON THEIR HOME BROUGHT THE ENTIRE RESIDENTIAL BUILDING CRASHING TO THE GROUND.

AND SHE LAID TRAP UNDER RUBBLE AWAITING RESCUE.

>> EVERY JOY FEELS LACKING WITHOUT THEM.

MY MOM AND I USED TO ARGUE A LOT.

NOW I WISH I COULD JUST HAVE ONE ARGUMENT WITH HER.

I WOULD JUST LIKE HER BACK.

>> THE BOMBING KILLED 73 PEOPLE, INCLUDING 23 CHILDREN.

THE VAST MAJORITY WERE CIVILIANS.

MORE THAN HALF OF THE WOMEN AND CHILDREN.

IT WAS THE SINGLE MASS CASUALTY EVENT OF THE WAR AND THE HIGHEST ON ANY STRIKE ON LEBANESE TERRITORY.

IN THE ISRAELI ARMY SAYS THAT THE AREA WAS THE BUILDING CENTER.

IN THE RUBBLE, WE FOUND HAIRBRUSHES AND CHILDREN'S TOYS AND BOOKS.

>> IT WAS NOT INVOLVED IN ANY MILITARY ACTION.

>> THEY HELPED FAMILIES LEFT BY THE WAR.

>> THEIR GRANDMOTHER CAN FIND METHANE.

- - THEIR GRANDMOTHER CAN FIND METHANE.

- - NOTHING.

>> IT LEAVES A SCAR ON YOUR HEART AND YOUR LIFE IS MEANINGLESS.

THEY STAY IN YOUR MIND AND THEY NEVER LEAVE YOU.

AND NOW IT IS A CONSTANT REMINDER OF ALL SHE HAS LOST.

>> THEY WERE SO HAPPY BACK THEN.

I KEEP THINKING ABOUT HER, I WANTED TO SEE HER GET MARRIED AND BE PROUD OF HER.

BUT NONE OF THAT HAPPENED, AND SHE NEVER GOT THE CHANCE.

>> A GRANDMOTHER AND ENDLESS MORNING.

BUT BARELY ALIVE.

THIS SILENCE CONTINUES TO CLAIM VICTIMS.

ALI: AS HEALTH INSURERS INCREASINGLY RELY ON ARTIFICIAL INTELLIGENCE TO PROCESS CLAIMS, DENIALS HAVE BEEN ON THE RISE.

IN RECENT YEARS, NEARLY 20% OF CLAIMS FILED BY AMERICANS ON AFFORDABLE CARE ACT PLANS WERE DENIED.

IN 2023 ALONE, THAT NUMBER ADDED UP TO ABOUT 73 MILLION PEOPLE WHO HAD FILED CLAIMS FOR IN-NETWORK SERVICES.

LESS THAN ONE PERCENT OF THEM TRIED TO APPEAL THEIR CLAIM, EITHER BECAUSE THE PROCESS WAS TOO LENGTHY OR TOO CONFUSING.

NOW, ARTIFICIAL INTELLIGENCE IS BEING USED TO HELP PATIENTS FIGHT BACK.

SOFTWARE COMPANIES ARE HARNESSING THE POWER OF AI TO CREATE DETAILED APPEAL LETTERS FOR PATIENTS IN A FRACTION OF THE TIME IT WOULD TAKE A HUMAN TO DO.

JOINING US TO TALK ABOUT THE AI BATTLE IN HEALTH INSURANCE IS JENNIFER OLIVA, PROFESSOR AT INDIANA UNIVERSITY'S MAOER SCHOOL OF LAW.

THANK YOU FOR JOINING US.

BEFORE WE TALK ABOUT NEW WAYS COMPANIES USING AI TO FIGHT BACK AGAINST CLAIM DENIAL, I WOULD LIKE TO TALK ABOUT HOW HEALTH INSURANCE COMPANIES HAVE UP UNTIL THIS POINT BEEN USING AI AND OTHER AUTOMATED PREDICTIVE ALGORITHMS TO WORK INTO THEIR CLAIM APPROVAL OR DENIAL SYSTEM.

ENNIFER: IT IS SOMEWHAT OF A MYSTERY BECAUSE THERE IS NO WAY TO KNOW FOR SURE.

THEY SENT OUT A SURVEY TO HEALTH INSURERS IN 2025, AND THE ANSWERED, 71% SAID WE ARE USING AI FOR UTILIZATION MANAGEMENT, WHICH MEANS THAT THEY'RE ADMITTING IN A SURVEY WHERE THEY CAN SAY WHATEVER THEY WANT, THAT THEY ARE USING IT FOR PRIOR AND CONCURRENT AUTHORIZATION PROCESSES.

IN ADDITION, I'LL ADD THAT THERE ARE SEVERAL LAWSUITS THAT ALLEGE THAT THIS IS GOING ON.

AND AS PART OF WHAT WE'VE LEARNED FROM THESE LAWSUITS, INDEED, SOME OF THE INSURERS HAVE SENT PATIENTS DENIAL LETTERS STATING THAT THE CLAIM WAS REVIEWED BY AN AI PROGRAM.

ALI: AND WE ALSO KNOW THAT A VERY SMALL NUMBER OF PEOPLE EVER TRY TO APPEAL THESE CLAIMS.

WHY IS THAT THE CASE?

WHY DON'T MORE PEOPLE TAKE ADVANTAGE OF THIS SYSTEM THAT EXISTS?

JENNIFER: I THINK THAT IT'S VERY COMPLICATED.

FIRST OF ALL, YOU HAVE TO REMEMBER THAT WHEN PEOPLE ARE IN THESE SITUATIONS, THEY'RE OFTEN IN A COMPLICATED OR AN EMERGENT ACUTE CARE, HEALTHCARE SITUATION.

SO IT ALL DEPENDS ON WHAT THEIR PRIOR KNOWLEDGE IS OF A VERY COMPLEX SYSTEM.

IF THEY HAVE THE RESOURCES AND ABILITY AT THE TIME WHEN THEY'RE IN EMERGENCY CARE, THE ICU, TO DEAL WITH A SITUATION THAT'S THIS COMPLEX.

IT'S TRUE, VERY FEW PEOPLE APPEAL, BUT A MAJORITY OF THE PEOPLE WHO APPEAL ARE VERY SUCCESSFUL.

ALI: WOW, THAT'S PRETTY REMARKABLE.

WE NOW HAVE SOFTWARE COMPANIES WHO ARE EMPLOYING AI TO HELP PEOPLE APPEAL THESE REJECTIONS.

HOW DOES THAT WORK?

WHAT DO WE KNOW ABOUT IT?

JENNIFER: YEAH, IT'S VERY INTERESTING.

THE SYSTEM ASKS YOU FOR ALL THE DOCUMENTATION THAT YOU HAVE THAT WOULD BE HELPFUL IN FILING THE APPEAL BASED ON WHAT THE INSURERS ARE EXPECTING.

AND YOU PAY LIKE A $40 OR $50 FEE AS A GENERAL RULE, AND THE AI CREATES A CLAIMS APPEALFOR YOU THAT YOU CAN SUBMIT TO YOUR INSURER.

IT SEEMS TO HAVE GONE WELL FOR THE PEOPLE THAT ARE IN THE SORT OF REPORTED CONVERSATIONS ABOUT THIS.

AND I WOULD ENCOURAGE PEOPLE TO REACH OUT TO THESE COMPANIES.

I THINK THE PROBLEM HERE IS THAT WE'RE IN AN AI ARMS RACE WHERE AS CONSUMERS BECOME MORE SAVVY AND ARE MORE EMPOWERED BY THESE TOOLS TO FIGHT BACK, THE INSURERS WILL JUST, YOU KNOW, UP THE ANTE ON THEIR SIDE WITH THE AI.

SO, WHAT I WOULD LIKE TO SEE IS A SYSTEM IN PLACE, WHERE THERE ARE FEWER DENIALS ON THE FRONT END THAT ARE ILLEGAL.

ALI: FAILING THAT THOUGH, WHAT DO WE KNOW ABOUT HOW THESE SYSTEMS WORK IN TERMS OF ARE PEOPLE ABLE TO JUST UPLOAD THEIR DENIAL AND PUT IN SOME ADDITIONAL INFORMATION AND SET THE AI TO WORK?

HOW DOES THAT WORK OPERATIONALLY?

JENNIFER: YEAH, THAT'S RIGHT.

YOU LIKE PUT IN YOUR INFORMATION.

THE SYSTEM ASKS YOU FOR ALL THE DOCUMENTATION THAT YOU HAVE THAT WE KNOW THEY DENY CLAIMS AT A HIGH RATE.

WE KNOW VERY FEW PEOPLE APPEAL.

WE ALSO KNOW THAT AI MAKES IT REALLY EASY FOR THEM TO DETECT PEOPLE WHO WON'T APPEAL BASED ON A LONG STANDING PAST HISTORY IN CLAIMS DATA.

AND ON PEOPLE WHO WON'T LIVE THROUGH AN APPEAL BASED ON THE TIME THAT THE APPEALS TAKE.

I'M VERY, VERY CONCERNED ABOUT ROBUST AI BEING USED ON THE INSURER SIDE TO PICK THROUGH THE DATA QUITE CAREFULLY TO CHOOSE VICTIMS WHO ARE EXPENSIVE AND WILL NOT OR PERHAPS WILL NOT LIVE THROUGH THEIR APPEAL.

THAT'S MY CONCERN ON THAT SIDE.

ON THE OPPOSITE SIDE, ON THE PROVIDER AND PATIENT SIDE, I AM GLAD THAT THEY HAVE THESE TO FIGHT BACK, BUT I JUST FEEL LIKE IT'S ALL GOING TO KEEP ESCALATING AND THE INSURERS WILL BECOME MORE SAVVY AND PROVIDERS AND PATIENTS DON'T HAVE THE SAME RESOURCES.

ALI: WHAT ABOUT THE REGULATORY LANDSCAPE HERE?

WHAT EXISTS IN TERMS OF PREVENTING SOME OF THAT ESCALATION THAT WE JUST TALKED ABOUT?

AND WHAT SHOULD BE IN PLACE?

JENNIFER: SO ALMOST NOTHING EXISTS.

THAT'S MY WHOLE INTEREST IN THIS FIELD.

IT IS VERY LIGHTLY REGULATED.

TO THE EXTENT THAT IT'S REGULATED, IT'S GENERALLY SOMETHING LIKE A HUMAN HAS TO BE IN THE LOOP.

A HUMAN HAS LIKE OVERSEE THE FINAL DETERMINATION.

BUT AS WE KNOW FROM INVESTIGATIVE REPORTING AND THE LAWSUITS THAT ARE PENDING, IT SEEMS LIKE THAT'S NOT THE CASE THAT HUMANS ARE JUST SORT OF APPROVING WHAT THE AI IS DECIDING ON THE INSURER SIDE.

AND SO WHAT I'VE BEEN ARGUING FOR IS WE NEED ROBUST REGULATION ON THE FRONT END TO MAKE SURE THAT THE AI TOOLS THAT THE INSURERS ARE USING ARE MAKING GOOD, ACCURATE, TRANSPARENT, AND VALID DECISIONS BASED ON THE PATIENT'S MEDICAL NECESSITY, WHICH THEY'RE REQUIRED TO BY LAW BASED ON THEIR PLAN CONTRACTS.

ALI: JENNIFER OLIVA, PROFESSOR OF LAW AT INDIANA UNIVERSITY, THANK YOU SO MUCH.

JENNIFER: THANK YOU FOR HAVING ME.

♪ ALI: THAT IS OUR PROGRAM FOR TONIGHT.

I'M ALI ROGIN.

FOR ALL OF MY COLLEAGUES, THANKS FOR JOINING US.

SEE YOU TOMORROW.

>> MAJOR FUNDING FOR PBS NEWS WEEKEND HAS BEEN PROVIDED BY -- IN THESE INSTITUTIONS.

> THIS PROGRAM WAS MADE POSSIBLE BY CONTRIBUTIONS TO YOUR PBS STATION FROM VIEWERS LIKE YOU.

THANK YOU.

♪