各界對於人工智慧主導醫療保險拒賠的擔憂日益加劇
Concerns grow over AI-based healthcare denials
Updated at: September 27, 2026 at 12:30 AM
近年來，將人工智慧整合至醫療產業引發了重大爭議。
In recent years, the integration of artificial intelligence into the healthcare industry has sparked significant debate.
健康保險公司正越來越頻繁地使用自動化演算法來進行「預先授權」，這是一種確定病患醫療處置是否獲得給付的流程。
Health insurers are increasingly using automated algorithms for "prior authorization," a process that determines if a patient's medical treatment will be covered.
雖然保險公司主張人工智慧能提升效率並協助管理龐大的索賠案量，但批評者將這些系統視為「黑箱」，認為它們將利潤置於病患福祉之上。
While insurance companies argue that AI improves efficiency and helps manage the massive volume of claims, critics view these systems as "black boxes" that prioritize profits over patient well-being.
報導指出些許人工智慧工具能在一秒多的時間內處理索賠案，導致自動拒賠率居高不下。
Reports suggest that some AI tools can process claims in just over a second, leading to high rates of automated denials.
醫師表示，這些系統往往會凌駕於他們的臨床專業判斷，造成必要醫療服務的障礙，並導致醫事人員職業倦怠。
Physicians argue that these systems often override their clinical expertise, creating barriers to essential care and contributing to professional burnout.
此外，由於病患極少被告知其個案使用了人工智慧，因此要對拒賠決定提出異議相當困難。
Furthermore, because patients are rarely informed when AI is used in their case, challenging a denial becomes difficult.
透明度不足已引發了一波訴訟與新立法，例如加州的 SB 1120 法案，該法案要求必須有人工監督。
The lack of transparency has led to a wave of lawsuits and new legislation, such as California's SB 1120, which demands human oversight.
隨著技術演進，醫療產業面臨著如何在行政效率與個別化、公正且由人類主導的醫療決策等基本需求之間取得平衡的挑戰。
As technology evolves, the healthcare sector faces the challenge of balancing administrative speed with the fundamental need for individualized, fair, and human-led medical decision-making.
