Artificial intelligence (AI) tools used by healthcare providers to identify patients’ secondary medical conditions contributed nearly $1 billion in additional costs for Blue Cross Blue Shield insurers over two years, according to a study released Thursday by the Blue Cross Blue Shield Association.
The findings, reported by Reuters on Thursday (Sept. 24), point to a growing financial consideration for insurers as healthcare providers adopt AI systems that can scan patient records and automatically identify additional conditions that may affect how claims are coded and reimbursed.
Between 2024 and 2025, providers more frequently billed for secondary conditions, driving an additional $653 million in costs for Blue Cross companies, the study found. More intensive care overall accounted for $942 million in additional costs over the two-year period compared with 2023.
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The Blue Cross Blue Shield Association (BCBSA) said providers have used AI technology, including ambient-scribe systems that listen to patient conversations and draft medical notes, to identify secondary conditions. When additional or coexisting conditions are documented, hospital claims can be classified as involving more complex care, resulting in higher payments from insurers.
The study analyzed inpatient billing data from hospitals and other medical facilities. BCBSA represents 31 independent Blue Cross Blue Shield insurers serving more than 100 million people.
The association said the increase in coded conditions does not necessarily indicate inappropriate use of AI. “If patients are truly sicker, we’d expect to see more treatment,” Luke Chalker, BCBSA’s senior vice president of product and data science, told Reuters.
The findings come as insurers have raised concerns about how healthcare systems are using AI-assisted tools to support reimbursement claims. Insurers including Centene have said AI adoption can contribute to aggressive or inappropriate payment requests, according to Reuters.
For major bowel surgeries, the study found that certain secondary conditions increased substantially between the first quarter of 2023 and the fourth quarter of 2025, including partial intestinal blockages and excessive acid levels in the body.
The results underscore how AI’s growing role in clinical documentation can affect not only administrative workflows but also the financial relationship between healthcare providers and insurers.
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