No. of Recommendations: 1
This Boston Globe article is behind a paywall, but says that Blue Cross plans to use computer algorithms to target overcharging. And some physicians are using AI to justify higher fees. There is no mention of what patients are supposed to do.
My primary care doctor used to charge reasonably, but my most recent annual checkup was double billed despite "no complaints today" and no medication. (The extra charge was CPT code 99214, which represents an office visit that requires a moderate level of medical decision-making or 30-39 minutes of total time.) My doctor would not say what the charge was for, only that it was for managing chronic conditions, and was quite upset with me for just asking what the extra charge was for. I've noticed that my medical chart is being populated with chronic conditions that I do not have symptoms for, and do not get medical advice on.
Insurance pays for it all, and so as a patient I have little motivation to do anything to fix the messed-up medical billing system.
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Blue Cross plans to target doctors for overcharging. Physicians are furious., October 24, 2025
"With the help of a computer algorithm, the state’s biggest health insurer says it will scrutinize doctors who frequently bill it for the most expensive patient visits. It will then unilaterally cut payments to physicians it concludes charged too much.
Targeting what it described as a small percentage of “outliers,” Blue Cross Blue Shield of Massachusetts plans to roll out the new program around Nov. 3. The insurer says health care costs are increasing at their fastest rate in more than 20 years and that it has a duty to help control them for its 3 million members.
But the move has angered some doctors, particularly those who often see older, medically complicated patients in need of more care and time. They say Blue Cross’s initiative fails to recognize a simple fact of medicine: Patients and treatments don’t fit neatly into categories used by insurers and software developers. ...
To carry out the program, Blue Cross is paying a Utah-based company, Cotiviti, which uses an algorithm as well as registered nurses to analyze claims, compare them to those of peer doctors, and identify physicians who overcharged, according to Amy McHugh, a spokesperson for the insurer.
In doing so, Blue Cross is engaging in a bit of high-tech tit for tat; Rao said that some of the physicians it plans to scrutinize may be charging higher fees because they rely on AI-powered transcription tools that listen to conversations between doctors and patients to automatically generate clinical notes. Those tools, she said, sometimes categorize appointments as more complex than they were."
https://www.bostonglobe.com/2025/10/24/business/bl... 