Thoughts on the ethics of health insurance companies using Data Science to increase profits based on selective coverage

I want to have a good discussion on this topic since no one is talking about it outside of just the context of a CEO making decisions, but as a lot of us know, company decisions and strategy are driven by the suits(board) and the higher ups a lot of times, and that strategy is trickled down to the analysts and other groups forming projects to support the strategic initiative. I think not talking about this from a data science perspective is an ethics violation because we as practitioners can make the decision to not engage or pursue a project just because “I have a boss and they told me I need to because it aligns with our strategy.” I personally have quit a job in the past because the ethics of the CV models we were creating dawned on me and didn’t make me feel right. Sure I could validate it by saying I was only creating a small part of the software system, the reality is I knew the end goal and was actively participating in the development of a system that could be used for an ethically questionable use case.

The possibility of UHCs actuarial science, analysts, and Data Scientists developing models to contribute to the strategy of increased profits and increased denials should be questioned. And I know “denial rates” aren’t apples to apples as back office rev cycle management people could wrongfully code a claim which can cause it to be denied. I’m talking more from a targeted perspective. Actuaries that work in insurance are very smart, but I want to get some insight about the specifics of what goes on from a health insurance perspective when they are denying a claim.

I would love to hear perspectives from both sides, especially those who may have worked in the industry.