> They have to use rules.

There are rules and then there are rules. It is the details of the particular rule that is of interest. The use of "AI" in that article seems like clickbait to me.

The article seems to suggest that predictions based on aggregate statistics are being applied to implement strict coverage approval for individuals. That seems like a complete misunderstanding of predictive value of those statistics for a particular individual. Not sure if that is gross incompetance or malfeasance. Either way, a problem.