Blue Cross Blue Shield Association (BCBSA) says AI‑driven medical coding added about $942 million to its health‑plan costs between 2023 and 2025. The increase comes mainly from extra secondary diagnoses that move patients into higher‑paying reimbursement categories. BCBSA estimates roughly 70% of that $942 million – about $653 million – was linked to diagnoses that did not change the care a patient received.
Hospitals have been adopting AI coding tools rapidly; BCBSA notes that 60% of hospital systems were using such tools during the same period. Insurers also use AI for claims review, but any denial must be checked by a human clinician, according to BCBSA.
What the numbers mean for patients
BCBSA warns that higher reimbursements without added care could eventually show up as higher insurance premiums and out‑of‑pocket costs for consumers. The firm’s senior vice president of product and data science, Luke Chalker, says the cost rise “could eventually … show up in the form of higher premiums and out‑of‑pocket costs.”
Industry analysts note an 8.2% projected increase in per‑employee health‑coverage costs for 2027, the biggest jump since 2003, which could be partly driven by these coding changes.
Why it matters
For ordinary consumers, the AI‑driven coding surge could mean higher health‑insurance premiums and out‑of‑pocket bills, even though the underlying care hasn’t changed. While hospitals say AI improves documentation, insurers warn the extra codes may simply inflate costs that get passed to members.
