AI denial is now your proxy paragraph.
Tokto gives the health-plan CEO one record that ties every AI denial, every clinical review, every ambient capture, and every PHI flow to a member and a plan, ready for the board, the activist investor, and the CMS administrator.
All three of the largest Medicare Advantage insurers are past motion to dismiss on AI denial. A federal court orders algorithmic disclosure. Congress calls a hearing. The CEO is asked, on national television, how the AI tool that denied a grandmother's post-acute care actually worked.
What you get with Tokto
- Every prompt tied to a member, a plan, a clinician, an authorization, and a denial code.
- A complete record for OIG, CMS, the state DOI, the ERISA plaintiff, the appellate panel, and the HIPAA auditor.
- Policy applied at the prompt: no AI denial without clinical review, no PHI to a vendor without contract.
- Defensibility under class certification, ERISA scrutiny, CIPA wiretap, and HIPAA audit at once.
How it works
Tokto governs the AI surface across the plan from the CEO's seat. Utilization-management co-pilots, ambient clinical scribes, prior-authorization triage, and vendor APIs flow through one record. The board, the CMS administrator, and the press read off the same trail.
When the District of Minnesota orders algorithmic disclosure, when ERISA appellate panels move past dismissal, when Congress calls a hearing, the CEO answers each one out of one record. The narrative is consistent across the proxy, the press release, and the CMS program audit.
What goes wrong without it
- An AI denial reaches a 90-percent reversal-on-appeal pattern. Congressional hearing follows the next quarter.
- An ambient clinical scribe captures patient audio without consent. National press picks up the CIPA suit.
- A vendor with PHI access has no current BAA. HIPAA breach disclosure follows. Investor relations gets the call.
- A federal court orders algorithmic disclosure. The plan and its model vendor produce inconsistent answers in the press cycle.
In March 2026, a federal judge in the District of Minnesota ordered UnitedHealth to disclose internal documents and source materials behind nH Predict, the AI tool used to manage Medicare Advantage post-acute care claims. Plaintiffs in the related Estate of Lokken class action cite a 90 percent reversal rate on appealed denials, with only 0.2 percent of patients ever appealing. The Lokken class was certified in February 2025.
See how Tokto makes enterprise AI visible, governed, and accountable for CEO & Board in Healthcare.
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