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MCO leaders tell Insurance Committee they do not use AI to make clinical denials; members press on provider access and responsiveness
Summary
Executives from BlueCare, UnitedHealthcare and WellPoint answered questions at a TennCare MCO hearing; each said clinicians make coverage decisions, defended provider support efforts, and faced pushed questions about long provider delays, rural access, and whether the MCO model is suitable going forward.
Executives from Tennessee's largest TennCare managed-care organizations told the Insurance Committee they do not use artificial intelligence to make clinical denial decisions and described efforts to support providers and members.
Casey Dungan, president and CEO of BlueCare (Blue Cross Blue Shield of Tennessee), said BlueCare ‘‘does not use AI to deny or adjust claims’’ and that clinical reviews affecting payment are conducted by qualified clinicians in accord with TennCare policy and federal rules. UnitedHealthcare's local CEO, Yuta Strand, and CFO James Kelly presented financial results and explained medical-loss-ratio trends, saying at least 85% of premium dollars must be spent on medical care in their TennCare contract. WellPoint's president Rachel Chenetti highlighted network size, accreditation and investment in care coordination.
Committee members pressed the MCOs on provider responsiveness and long delays; representatives described examples of contracts or provider issues taking months to resolve and asked MCOs for concrete solutions. MCO leaders said they maintain dedicated provider-support teams, conduct provider meetings and will personally escalate prolonged cases. Committee members also debated the larger MCO model; one member suggested exploring opening the market and another questioned whether legislative solutions should go further.
The hearing concluded with members thanking the MCOs and urging continued work with providers and TennCare to resolve access and administrative issues. The committee adjourned without further votes on those topics.
