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Irresponsible AI Implementation
I submitted a claim on 2/10/26 for my dog, for a tooth injury sustained during ball play. The tooth injury required an evaluation by the vet, surgical deposit, and surgery for extraction of the broken tooth. I prepared a summary describing the injury along with a detailed analysis of costs and invoices associated with the injury. I provided the summary along with all invoices and medical records to MetLife to ensure clarity for the injury and associated costs. Unfortunately, nobody at MetLife actually reviewed any of the documentation provided for the claim. Instead, MetLife's auto-adjudicator (AI) has now divided my claim into 7 different claims. I received two partial payments, the total of which is still well below my total costs for the injury. I also do not have clarity on what these payments are supposed to be covering, and what is being denied, because the EOB doesn't provide any detail on the amounts covered. I have called MetLife 5 times now to try and resolve this situation. The customer experience center has sent my claim back to the claims dept to be re-reviewed at least 3 times. Two of the customer service representatives told me about the auto-adjudicator and indicated that no human actually reviewed my claim or documentation. Each time my claim has been sent back to the claims department, I am assured that an actual human will review everything this time. When I just called for the 5th time, the customer service representative told me again that my claim was reviewed by the auto-adjudicator only despite being sent back to the claims dept for re-review by a human previously. I understand we are all trying to incorporate AI into our workflows to create efficiencies. However, it is incredibly irresponsible for MetLife to implement an AI claim review process with no internal human review process to check the AI's work prior to final claim decision & payment. It is also incredibly frustrating (and unfair to MetLife's customer experience reps) for customers to be continually routed to a customer experience call center that has no recourse to help aside from repeatedly sending claims back to the claims department for re-review, potentially by the same AI system that is erroneously reviewing claims in the first place. As a customer, I would rather wait longer for my claim to process and have it done right, than have it done quickly but wrong and require hours of my valuable time & effort to resolve. I am very close to cancelling my policy with MetLife, and wanted to share the reason in the hopes that it helps improve processes for other customers.
Insurer: MetLife
By: Jen
Irresponsible AI Implementation
I submitted a claim on 2/10/26 for my dog, for a tooth injury sustained during ball play. The tooth injury required an evaluation by the vet, surgical deposit, and surgery for extraction of the broken tooth. I prepared a summary describing the injury along with a detailed analysis of costs and invoices associated with the injury. I provided the summary along with all invoices and medical records to MetLife to ensure clarity for the injury and associated costs. Unfortunately, nobody at MetLife actually reviewed any of the documentation provided for the claim. Instead, MetLife's auto-adjudicator (AI) has now divided my claim into 7 different claims. I received two partial payments, the total of which is still well below my total costs for the injury. I also do not have clarity on what these payments are supposed to be covering, and what is being denied, because the EOB doesn't provide any detail on the amounts covered. I have called MetLife 5 times now to try and resolve this situation. The customer experience center has sent my claim back to the claims dept to be re-reviewed at least 3 times. Two of the customer service representatives told me about the auto-adjudicator and indicated that no human actually reviewed my claim or documentation. Each time my claim has been sent back to the claims department, I am assured that an actual human will review everything this time. When I just called for the 5th time, the customer service representative told me again that my claim was reviewed by the auto-adjudicator only despite being sent back to the claims dept for re-review by a human previously. I understand we are all trying to incorporate AI into our workflows to create efficiencies. However, it is incredibly irresponsible for MetLife to implement an AI claim review process with no internal human review process to check the AI's work prior to final claim decision & payment. It is also incredibly frustrating (and unfair to MetLife's customer experience reps) for customers to be continually routed to a customer experience call center that has no recourse to help aside from repeatedly sending claims back to the claims department for re-review, potentially by the same AI system that is erroneously reviewing claims in the first place. As a customer, I would rather wait longer for my claim to process and have it done right, than have it done quickly but wrong and require hours of my valuable time & effort to resolve. I am very close to cancelling my policy with MetLife, and wanted to share the reason in the hopes that it helps improve processes for other customers.
Insurer: MetLife
By: Jen
Irresponsible AI Implementation
I submitted a claim on 2/10/26 for my dog, for a tooth injury sustained during ball play. The tooth injury required an evaluation by the vet, surgical deposit, and surgery for extraction of the broken tooth. I prepared a summary describing the injury along with a detailed analysis of costs and invoices associated with the injury. I provided the summary along with all invoices and medical records to MetLife to ensure clarity for the injury and associated costs. Unfortunately, nobody at MetLife actually reviewed any of the documentation provided for the claim. Instead, MetLife's auto-adjudicator (AI) has now divided my claim into 7 different claims. I received two partial payments, the total of which is still well below my total costs for the injury. I also do not have clarity on what these payments are supposed to be covering, and what is being denied, because the EOB doesn't provide any detail on the amounts covered. I have called MetLife 5 times now to try and resolve this situation. The customer experience center has sent my claim back to the claims dept to be re-reviewed at least 3 times. Two of the customer service representatives told me about the auto-adjudicator and indicated that no human actually reviewed my claim or documentation. Each time my claim has been sent back to the claims department, I am assured that an actual human will review everything this time. When I just called for the 5th time, the customer service representative told me again that my claim was reviewed by the auto-adjudicator only despite being sent back to the claims dept for re-review by a human previously. I understand we are all trying to incorporate AI into our workflows to create efficiencies. However, it is incredibly irresponsible for MetLife to implement an AI claim review process with no internal human review process to check the AI's work prior to final claim decision & payment. It is also incredibly frustrating (and unfair to MetLife's customer experience reps) for customers to be continually routed to a customer experience call center that has no recourse to help aside from repeatedly sending claims back to the claims department for re-review, potentially by the same AI system that is erroneously reviewing claims in the first place. As a customer, I would rather wait longer for my claim to process and have it done right, than have it done quickly but wrong and require hours of my valuable time & effort to resolve. I am very close to cancelling my policy with MetLife, and wanted to share the reason in the hopes that it helps improve processes for other customers.
Insurer: MetLife
By: Jen
Irresponsible AI Implementation
I submitted a claim on 2/10/26 for my dog, for a tooth injury sustained during ball play. The tooth injury required an evaluation by the vet, surgical deposit, and surgery for extraction of the broken tooth. I prepared a summary describing the injury along with a detailed analysis of costs and invoices associated with the injury. I provided the summary along with all invoices and medical records to MetLife to ensure clarity for the injury and associated costs. Unfortunately, nobody at MetLife actually reviewed any of the documentation provided for the claim. Instead, MetLife's auto-adjudicator (AI) has now divided my claim into 7 different claims. I received two partial payments, the total of which is still well below my total costs for the injury. I also do not have clarity on what these payments are supposed to be covering, and what is being denied, because the EOB doesn't provide any detail on the amounts covered. I have called MetLife 5 times now to try and resolve this situation. The customer experience center has sent my claim back to the claims dept to be re-reviewed at least 3 times. Two of the customer service representatives told me about the auto-adjudicator and indicated that no human actually reviewed my claim or documentation. Each time my claim has been sent back to the claims department, I am assured that an actual human will review everything this time. When I just called for the 5th time, the customer service representative told me again that my claim was reviewed by the auto-adjudicator only despite being sent back to the claims dept for re-review by a human previously. I understand we are all trying to incorporate AI into our workflows to create efficiencies. However, it is incredibly irresponsible for MetLife to implement an AI claim review process with no internal human review process to check the AI's work prior to final claim decision & payment. It is also incredibly frustrating (and unfair to MetLife's customer experience reps) for customers to be continually routed to a customer experience call center that has no recourse to help aside from repeatedly sending claims back to the claims department for re-review, potentially by the same AI system that is erroneously reviewing claims in the first place. As a customer, I would rather wait longer for my claim to process and have it done right, than have it done quickly but wrong and require hours of my valuable time & effort to resolve. I am very close to cancelling my policy with MetLife, and wanted to share the reason in the hopes that it helps improve processes for other customers.
Insurer: MetLife
By: Jen
Irresponsible AI Implementation
I submitted a claim on 2/10/26 for my dog, for a tooth injury sustained during ball play. The tooth injury required an evaluation by the vet, surgical deposit, and surgery for extraction of the broken tooth. I prepared a summary describing the injury along with a detailed analysis of costs and invoices associated with the injury. I provided the summary along with all invoices and medical records to MetLife to ensure clarity for the injury and associated costs. Unfortunately, nobody at MetLife actually reviewed any of the documentation provided for the claim. Instead, MetLife's auto-adjudicator (AI) has now divided my claim into 7 different claims. I received two partial payments, the total of which is still well below my total costs for the injury. I also do not have clarity on what these payments are supposed to be covering, and what is being denied, because the EOB doesn't provide any detail on the amounts covered. I have called MetLife 5 times now to try and resolve this situation. The customer experience center has sent my claim back to the claims dept to be re-reviewed at least 3 times. Two of the customer service representatives told me about the auto-adjudicator and indicated that no human actually reviewed my claim or documentation. Each time my claim has been sent back to the claims department, I am assured that an actual human will review everything this time. When I just called for the 5th time, the customer service representative told me again that my claim was reviewed by the auto-adjudicator only despite being sent back to the claims dept for re-review by a human previously. I understand we are all trying to incorporate AI into our workflows to create efficiencies. However, it is incredibly irresponsible for MetLife to implement an AI claim review process with no internal human review process to check the AI's work prior to final claim decision & payment. It is also incredibly frustrating (and unfair to MetLife's customer experience reps) for customers to be continually routed to a customer experience call center that has no recourse to help aside from repeatedly sending claims back to the claims department for re-review, potentially by the same AI system that is erroneously reviewing claims in the first place. As a customer, I would rather wait longer for my claim to process and have it done right, than have it done quickly but wrong and require hours of my valuable time & effort to resolve. I am very close to cancelling my policy with MetLife, and wanted to share the reason in the hopes that it helps improve processes for other customers.
Insurer: MetLife
By: Jen
Irresponsible AI Implementation
I submitted a claim on 2/10/26 for my dog, for a tooth injury sustained during ball play. The tooth injury required an evaluation by the vet, surgical deposit, and surgery for extraction of the broken tooth. I prepared a summary describing the injury along with a detailed analysis of costs and invoices associated with the injury. I provided the summary along with all invoices and medical records to MetLife to ensure clarity for the injury and associated costs. Unfortunately, nobody at MetLife actually reviewed any of the documentation provided for the claim. Instead, MetLife's auto-adjudicator (AI) has now divided my claim into 7 different claims. I received two partial payments, the total of which is still well below my total costs for the injury. I also do not have clarity on what these payments are supposed to be covering, and what is being denied, because the EOB doesn't provide any detail on the amounts covered. I have called MetLife 5 times now to try and resolve this situation. The customer experience center has sent my claim back to the claims dept to be re-reviewed at least 3 times. Two of the customer service representatives told me about the auto-adjudicator and indicated that no human actually reviewed my claim or documentation. Each time my claim has been sent back to the claims department, I am assured that an actual human will review everything this time. When I just called for the 5th time, the customer service representative told me again that my claim was reviewed by the auto-adjudicator only despite being sent back to the claims dept for re-review by a human previously. I understand we are all trying to incorporate AI into our workflows to create efficiencies. However, it is incredibly irresponsible for MetLife to implement an AI claim review process with no internal human review process to check the AI's work prior to final claim decision & payment. It is also incredibly frustrating (and unfair to MetLife's customer experience reps) for customers to be continually routed to a customer experience call center that has no recourse to help aside from repeatedly sending claims back to the claims department for re-review, potentially by the same AI system that is erroneously reviewing claims in the first place. As a customer, I would rather wait longer for my claim to process and have it done right, than have it done quickly but wrong and require hours of my valuable time & effort to resolve. I am very close to cancelling my policy with MetLife, and wanted to share the reason in the hopes that it helps improve processes for other customers.
Insurer: MetLife
By: Jen
Irresponsible AI Implementation
I submitted a claim on 2/10/26 for my dog, for a tooth injury sustained during ball play. The tooth injury required an evaluation by the vet, surgical deposit, and surgery for extraction of the broken tooth. I prepared a summary describing the injury along with a detailed analysis of costs and invoices associated with the injury. I provided the summary along with all invoices and medical records to MetLife to ensure clarity for the injury and associated costs. Unfortunately, nobody at MetLife actually reviewed any of the documentation provided for the claim. Instead, MetLife's auto-adjudicator (AI) has now divided my claim into 7 different claims. I received two partial payments, the total of which is still well below my total costs for the injury. I also do not have clarity on what these payments are supposed to be covering, and what is being denied, because the EOB doesn't provide any detail on the amounts covered. I have called MetLife 5 times now to try and resolve this situation. The customer experience center has sent my claim back to the claims dept to be re-reviewed at least 3 times. Two of the customer service representatives told me about the auto-adjudicator and indicated that no human actually reviewed my claim or documentation. Each time my claim has been sent back to the claims department, I am assured that an actual human will review everything this time. When I just called for the 5th time, the customer service representative told me again that my claim was reviewed by the auto-adjudicator only despite being sent back to the claims dept for re-review by a human previously. I understand we are all trying to incorporate AI into our workflows to create efficiencies. However, it is incredibly irresponsible for MetLife to implement an AI claim review process with no internal human review process to check the AI's work prior to final claim decision & payment. It is also incredibly frustrating (and unfair to MetLife's customer experience reps) for customers to be continually routed to a customer experience call center that has no recourse to help aside from repeatedly sending claims back to the claims department for re-review, potentially by the same AI system that is erroneously reviewing claims in the first place. As a customer, I would rather wait longer for my claim to process and have it done right, than have it done quickly but wrong and require hours of my valuable time & effort to resolve. I am very close to cancelling my policy with MetLife, and wanted to share the reason in the hopes that it helps improve processes for other customers.
Insurer: MetLife
By: Jen
Irresponsible AI Implementation
I submitted a claim on 2/10/26 for my dog, for a tooth injury sustained during ball play. The tooth injury required an evaluation by the vet, surgical deposit, and surgery for extraction of the broken tooth. I prepared a summary describing the injury along with a detailed analysis of costs and invoices associated with the injury. I provided the summary along with all invoices and medical records to MetLife to ensure clarity for the injury and associated costs. Unfortunately, nobody at MetLife actually reviewed any of the documentation provided for the claim. Instead, MetLife's auto-adjudicator (AI) has now divided my claim into 7 different claims. I received two partial payments, the total of which is still well below my total costs for the injury. I also do not have clarity on what these payments are supposed to be covering, and what is being denied, because the EOB doesn't provide any detail on the amounts covered. I have called MetLife 5 times now to try and resolve this situation. The customer experience center has sent my claim back to the claims dept to be re-reviewed at least 3 times. Two of the customer service representatives told me about the auto-adjudicator and indicated that no human actually reviewed my claim or documentation. Each time my claim has been sent back to the claims department, I am assured that an actual human will review everything this time. When I just called for the 5th time, the customer service representative told me again that my claim was reviewed by the auto-adjudicator only despite being sent back to the claims dept for re-review by a human previously. I understand we are all trying to incorporate AI into our workflows to create efficiencies. However, it is incredibly irresponsible for MetLife to implement an AI claim review process with no internal human review process to check the AI's work prior to final claim decision & payment. It is also incredibly frustrating (and unfair to MetLife's customer experience reps) for customers to be continually routed to a customer experience call center that has no recourse to help aside from repeatedly sending claims back to the claims department for re-review, potentially by the same AI system that is erroneously reviewing claims in the first place. As a customer, I would rather wait longer for my claim to process and have it done right, than have it done quickly but wrong and require hours of my valuable time & effort to resolve. I am very close to cancelling my policy with MetLife, and wanted to share the reason in the hopes that it helps improve processes for other customers.
Insurer: MetLife
By: Jen
Irresponsible AI Implementation
I submitted a claim on 2/10/26 for my dog, for a tooth injury sustained during ball play. The tooth injury required an evaluation by the vet, surgical deposit, and surgery for extraction of the broken tooth. I prepared a summary describing the injury along with a detailed analysis of costs and invoices associated with the injury. I provided the summary along with all invoices and medical records to MetLife to ensure clarity for the injury and associated costs. Unfortunately, nobody at MetLife actually reviewed any of the documentation provided for the claim. Instead, MetLife's auto-adjudicator (AI) has now divided my claim into 7 different claims. I received two partial payments, the total of which is still well below my total costs for the injury. I also do not have clarity on what these payments are supposed to be covering, and what is being denied, because the EOB doesn't provide any detail on the amounts covered. I have called MetLife 5 times now to try and resolve this situation. The customer experience center has sent my claim back to the claims dept to be re-reviewed at least 3 times. Two of the customer service representatives told me about the auto-adjudicator and indicated that no human actually reviewed my claim or documentation. Each time my claim has been sent back to the claims department, I am assured that an actual human will review everything this time. When I just called for the 5th time, the customer service representative told me again that my claim was reviewed by the auto-adjudicator only despite being sent back to the claims dept for re-review by a human previously. I understand we are all trying to incorporate AI into our workflows to create efficiencies. However, it is incredibly irresponsible for MetLife to implement an AI claim review process with no internal human review process to check the AI's work prior to final claim decision & payment. It is also incredibly frustrating (and unfair to MetLife's customer experience reps) for customers to be continually routed to a customer experience call center that has no recourse to help aside from repeatedly sending claims back to the claims department for re-review, potentially by the same AI system that is erroneously reviewing claims in the first place. As a customer, I would rather wait longer for my claim to process and have it done right, than have it done quickly but wrong and require hours of my valuable time & effort to resolve. I am very close to cancelling my policy with MetLife, and wanted to share the reason in the hopes that it helps improve processes for other customers.
Insurer: MetLife
By: Jen
Irresponsible AI Implementation
I submitted a claim on 2/10/26 for my dog, for a tooth injury sustained during ball play. The tooth injury required an evaluation by the vet, surgical deposit, and surgery for extraction of the broken tooth. I prepared a summary describing the injury along with a detailed analysis of costs and invoices associated with the injury. I provided the summary along with all invoices and medical records to MetLife to ensure clarity for the injury and associated costs. Unfortunately, nobody at MetLife actually reviewed any of the documentation provided for the claim. Instead, MetLife's auto-adjudicator (AI) has now divided my claim into 7 different claims. I received two partial payments, the total of which is still well below my total costs for the injury. I also do not have clarity on what these payments are supposed to be covering, and what is being denied, because the EOB doesn't provide any detail on the amounts covered. I have called MetLife 5 times now to try and resolve this situation. The customer experience center has sent my claim back to the claims dept to be re-reviewed at least 3 times. Two of the customer service representatives told me about the auto-adjudicator and indicated that no human actually reviewed my claim or documentation. Each time my claim has been sent back to the claims department, I am assured that an actual human will review everything this time. When I just called for the 5th time, the customer service representative told me again that my claim was reviewed by the auto-adjudicator only despite being sent back to the claims dept for re-review by a human previously. I understand we are all trying to incorporate AI into our workflows to create efficiencies. However, it is incredibly irresponsible for MetLife to implement an AI claim review process with no internal human review process to check the AI's work prior to final claim decision & payment. It is also incredibly frustrating (and unfair to MetLife's customer experience reps) for customers to be continually routed to a customer experience call center that has no recourse to help aside from repeatedly sending claims back to the claims department for re-review, potentially by the same AI system that is erroneously reviewing claims in the first place. As a customer, I would rather wait longer for my claim to process and have it done right, than have it done quickly but wrong and require hours of my valuable time & effort to resolve. I am very close to cancelling my policy with MetLife, and wanted to share the reason in the hopes that it helps improve processes for other customers.
Insurer: MetLife
By: Jen