Imagine starting a life-changing treatment, only to be stuck waiting for days—or even weeks—just to find out if your insurance will cover it. This frustrating delay is a reality for countless patients, but Amgen is fighting back with a groundbreaking AI solution.
When it comes to accessing essential medications, time is of the essence. Delays in verifying insurance coverage can be more than just an inconvenience; they can deter patients from starting their prescribed treatment altogether. Amgen’s U.S. Patient Access & Reimbursement (PAR) team is tackling this critical issue head-on by harnessing the power of artificial intelligence (AI). By automating key aspects of the benefit verification process, they’re ensuring that both healthcare providers and patients receive crucial coverage information faster than ever before—sometimes in a matter of hours rather than days.
Meet Eva: The AI Revolutionizing Benefit Verification
At the heart of this innovation is Eva, an AI agent developed by Infinitus Systems, Inc. (https://www.infinitus.ai/). Eva isn’t just another chatbot; it’s a sophisticated tool designed to complement human expertise. When contacting health insurers, Eva identifies itself as an automated system, swiftly gathering coverage details and generating benefit statements with remarkable reliability. Importantly, it always provides an option to connect with a human representative, ensuring a balance between efficiency and personalized care.
Traditionally, benefit verification could drag on for up to five days. But with Eva and expanded automation, Amgen now aims to deliver answers to patients within 48 hours—often even sooner, depending on payer response times. While final coverage decisions remain in the hands of payers and human reimbursement specialists, Eva’s role is to streamline the process by efficiently collecting and summarizing benefit data for review.
But here’s where it gets controversial: Eva doesn’t rely on scripted questions. Instead, it leverages natural language processing and machine learning to interpret and respond to payer data, marking a significant departure from traditional automation methods. Is this the future of healthcare communication, or does it risk losing the human touch?
“Eva’s ability to expedite the benefit verification process is a game-changer,” explains Ravi Dave, Director of Call Center Operations. “By providing faster access to coverage information, we’re helping patients start their prescribed treatments without unnecessary delays.”
To ensure accuracy and fairness, all AI-generated responses undergo rigorous review by trained Amgen staff. Eva is also subject to ongoing testing to identify and mitigate potential algorithmic biases, a critical step in maintaining trust in AI-driven systems.
Combining Human Care with AI Innovation
What sets Eva apart is its ability to continuously improve based on past interactions, thanks to Infinitus’ payer intelligence knowledge graph. This graph is enhanced through controlled learning using de-identified, aggregated data—ensuring that personally identifiable or protected health information (PHI) is never used to train general models.
Unlike basic algorithm-driven bots, Eva evolves with every call, becoming more accurate and efficient. It can even flag anomalies, like out-of-network referrals, and ask clarifying questions to deliver more precise results. This means providers and patients receive timely, accurate benefit information, while call center staff can focus on what they do best: offering empathy, guidance, and direct support.
And this is the part most people miss: It’s not just about efficiency—it’s about impact. “Every moment saved in the process helps ensure that time is spent where it matters most: improving lives,” says Ankit Jain, CEO and co-founder of Infinitus. Todd Boyd, Senior Director of Patient Access & Reimbursement at Amgen’s SupportPlus Call Center, adds, “Eva’s functionality is transforming how we serve patients, demonstrating how AI can adapt to the unique complexities of healthcare.”
Amgen’s commitment to responsible AI doesn’t stop there. They conduct AI impact assessments and maintain a robust risk-management program aligned with emerging state AI governance frameworks. These safeguards ensure transparency, accountability, and continuous oversight of AI systems used to support patient access. For more details on Amgen’s ethical AI practices, click here (https://wwwext.amgen.com/about/how-we-operate/policies-practices-and-disclosures/artificial-intelligence-vision).
Thought-Provoking Question: As AI becomes increasingly integrated into healthcare, how do we strike the right balance between innovation and preserving the human element of patient care? Share your thoughts in the comments below—we’d love to hear your perspective!
