A new report from PwC projects medical costs will rise 9 percent in the employer market and 8.5 percent in the individual market next year — with one of the biggest drivers being providers’ growing use of AI-powered billing and documentation tools.
According to the report, hospitals and providers are increasingly using AI-enabled software and digital scribes to document care in greater detail and capture higher billing complexity. In plain English: AI is helping providers bill more — and employers and patients are absorbing the cost.
The report found those higher costs aren’t primarily being driven by people using more care. Instead, they’re being driven by changes in coding severity, case mix, and higher payments per claim.
That’s exactly why lawmakers in North Carolina have started raising red flags that AI-driven upcoding is becoming one of the major drivers of healthcare inflation.
When AI is used to maximize billing rather than improve care, it creates a powerful incentive to make healthcare more expensive without making it better.
And because much of that spending is hidden inside employer-sponsored coverage, many workers never see the full impact. It shows up in smaller paychecks, lower wage growth, and higher premiums.
This is the affordability challenge policymakers cannot afford to ignore.
AI can improve patient care. It can reduce paperwork, speed diagnoses, and improve outcomes. But without transparency and accountability, it can also supercharge the same billing practices that are already driving healthcare costs out of reach.
North Carolina has an opportunity to get ahead of this. Policymakers will have to act before AI-driven billing becomes just another hidden cost families are forced to pay.
