10 ms·

Dark Algorithms and UX in Health Insurance

203 points by luu 9y ago

pweissbrod 9y ago
Im disappointed to confirm these are quite real. I've seen a particular case where a benefits enrollment page has a check box list where your selected enrollments at the top of the page _silently change as you edit fields near the bottom_. And you can bet which direction those values change. It doesnt hide a submission button like the author's example but it DOES prey on those who neglect to review their submission in full before continuing (which I guarantee is a significant and quantifiable benefit to the payer) It's a big stretch of the imgaination to dismiss this behavior as 'designer error'. This is a great example of where class action lawsuits can and should be employed.
fnordsensei 9y ago
Let's forget ethics for a moment, is there any decent way to calculate the difference in bottom line between creating and providing a great service (presumably leading to a good reputation, and maybe better, more long-lasting relationships with customers), and squeezing and weaseling every penny out of your customers and doing everything in your power to keep them from using the service they bought (presumably leading to bad reputation, but more cash upfront)? In some industries/companies/communities/what-have-you, there seems to be this consensus that exploitation, scamming and backstabbing is the obvious way to make the big bucks. Is this objectively true, or is it just some kind of oral history and tradition handed down from 1800s industrialists?
- laurent123456 9y ago
  One thing they could do is assign a score to each insuree (and I guess they already do something like this) based on the number of past claims and likelihood there will be more. Depending on that score they present more or less dark UI patterns to that user. Past a certain threshold they probably don't want to keep the insuree anyway, so if they switch it's still good for the insurer. They can calculate the likelihood the user will switch and how much the insurer will lose in premium, versus how much they'll win if they delay claims as much as possible.
  - taneq 9y ago
    I'm pretty sure "vary your evilness based on how much you think someone's worth to you" is an evil pattern. :P
    - gergles 9y ago
      That may be, but it's still incredibly common. Look up the concept of LTV. I have personal experience in customer service scenarios where people classed by 'the computer' with an LTV score below a certain value were not to be retained if they wanted to cancel our service (c.f. for a higher level LTV customer we might offer a promotion or something) and people with a score even lower were to be actively encouraged to leave if they reported any problems - even to the point where we were supposed to suggest they try somebody else rather than spending any time fixing their problems. Granted, these were (allegedly) people who were actively costing the company money in that it cost more to service their account than the revenue they provided, but it was an automated decision made by an algorithm that the phone and retail reps just had to enforce.
- zer0t3ch 9y ago
  I think that's pretty heavily reliant on the rest of the industry. If it's an industry that no one feels very strongly about, there's probably something to be said for hanging out in the middle: some scummy shit, but no nickle and diming. If it's something significant where every company is hated already, a new company coming in with nothing more than "we want nothing more than to provide a good service" is likely going to thrive.
  - twobyfour 9y ago
    That assumes the customer is the one who chooses. With most Americans getting insurance through their employers, they don't have the option to choose a less crappy insurer even if they trusted the claims of better service.
- kiliantics 9y ago
  If you don't resort to the weaseling, then you lose out to the competition. Capitalism is a system which naturally selects for the most scammy actors to survive and thrive.
  - ams6110 9y ago
    Your comment makes no sense. Do you as a customer seek out the most scammy companies to do business with?
    - kiliantics 9y ago
      Sometimes, there are only scammy businesses left, after they have out-competed any alternatives through dirty tactics that their competitors refused to resort to.
      - fnordsensei 9y ago
        But then the non-scammy should have a business opportunity in breaking the status quo.
- hvindin 9y ago
  I would question the incentives for an insurance company to reject claims arbitrarily or to not make the process for submitted claims at the very least adequate for two reasons: 1. If you insure a bunch of people against, in short, stuff that can kill them, then it's really in your best financial interests to be making sure that as many of those people as possible are seeing a doctor as regularly as possible (within reason) because that's how you avoid situations where someone makes shitty healthcare decisions for 3 decades then suddenly needs every imaginable treatment for every imaginable ailment that said person, who is obviously not a healthcare professional, would have never seen coming because they weren't regularly attending to their health in a low cost consistent kind of way, instead they just let their health deteriorate until it was an emergency. Which, from my understanding, especially in America, is where the vultures pounce to ensure your insurance companies pays top dollar for critical drugs and treatment. 2. On a purely accounting note, wouldn't this just fuck up your cash flow figures? I mean, if someone needs to get their insurer to pay for something because they don't have another option and they try and claim for that thing, isn't it in your best interest to make sure you pay out the amount at least reasonably quickly because, especially if you're acting in bad faith, their going to eventually break their way through the system to the "submit claim button" through sheer hours of trying, or their going to end up in court because they don't have other options. Then you've suddenly got a massive lump sum payout that probably wasn't in your forecasted expenses. To me, that just sounds like unpredictable silliness. But then again, I live in a country with free health insurance so I genuinely could be entirely missing the mark here and it could genuinely be more profitable to pinch your pennies as an insurer.
  - comatose 9y ago
    It doesn't necessarily follow that the most profitable path will be taken by middle managers, they often have perverse incentives, real or imagined, to cut costs short term even when the company would be better off if the insured stay healthy!
- bbddg 9y ago
  I think for most insurers it's more profitable to provide less service and preventative care for two specific reasons. One, once a person is 65 they are covered by Medicare and are the government's problem. Two, if someone under 65 does get seriously sick or injured, chances are they're going to have to leave their job or get fired. With most people getting insurance through work, the insurance company isn't on the hook anymore either.
  - nradov 9y ago
    The ACA required most health plans to provide free preventive health services. https://www.healthcare.gov/coverage/preventive-care-benefits/ https://www.healthcare.gov/coverage/preventive-care-benefits...
hanklazard 9y ago
Not a dark UX, but another move I’ve seen that is line with the stall-for-time method that the author mentions is the requirement for a prior authorization, even for very common medicines. I have seen first-hand the amount of work this tactic creates in medical offices. It definitely allows insurance companies to stall in their approval/payment for medicines and, I’m sure in a % of cases, not pay at all (ie, the paperwork doesn’t get completed, patient gives up trying to navigate the complexity of the system).
- jimktrains2 9y ago
  My most hated is "The thing your doctor did was not medically necessary, therefore we won't cover it."
panic 9y ago
Meanwhile, these insurance companies are making billions of dollars of profit (https://www.axios.com/profits-are-booming-at-health-insurance-companies-1513302495-18f3710a-c0b4-4ce3-8b7f-894a755e6679.html https://www.axios.com/profits-are-booming-at-health-insuranc...). There's no reason insurance companies need to be involved in health care at all.
- Ntrails 9y ago
  > There's no reason insurance companies need to be involved in health care at all. As a Brit I sort of agree, because I think free healthcare at point of delivery is the right solution. However the more continental model works perfectly well and many countries use private insurers for that sort of model. Insurance companies have a lot of expertise in risk management, analysis and costing so to claim that they've no place in healthcare is odd.
  - beat 9y ago
    Getting far afield here, but... there's something uniquely broken about the financial model of the US system. Pretty much every industrialized nation in the world pays about half as much per capita as the US does for its health care, and pretty much all of them provide universal coverage. And this is everyone, from purely socialist systems to mostly private systems. Which is why I have issues with both the right-wing insistence that nothing is wrong with ours that a little more free market can't cure, and the left-wing insistence that only a purely socialist single payer system will provide financial responsibility and social justice.
- ams6110 9y ago
  Billions of profit out of trillions spent on health care. Insurance company profits are not the real problem with health care costs.
  - shkkmo 9y ago
    Insurance profits seems to make up only about 1% of our total private healthcare expenditures. However, that doesn't take into account the amount of those healthcare expenditures that are being spent to generate those profits rather than to provide healthcare. It also doesn't account for the additional costs to non-insurers from systemic problems created and maintained insurers to increase their profits. (E.G. pushing filing/approval costs onto physician's offices or systemically fixing prices). So while Insurance company profits are not the direct cause of the outlandish healthcare costs in the US, they are a huge contributor to our problem and a core driver for many of it's multitudinous factors.
jawns 9y ago
This post lists three examples of dark algs/UX. However, the second and third examples are speculative. They might be a result of an algorithm, or they might be a result of stupid policies, or they might be a result of operational errors. Who knows? Alleging that it's a "dark algorithm" sounds cool, but it isn't really damning without evidence. So we're down to one example of actual dark UX, which doesn't make for a particularly strong allegation. I wish the author had taken just a little more time before publishing to collect a few other authentic examples. That said, I know from my own experience that health insurers' online portals tend to have horrible UX, because it is not in their best interest to have great UX. Just yesterday, I had to fill out a form indicating that none of the five members of my household had other insurance or were Medicaid-eligible. There were a total of 10 checkboxes I had to check. After checking each one, I got a loading indicator and then the page refreshed, so I had to scroll the page back down to the next checkbox. It didn't prevent me from filling in the information, but it definitely made it needlessly tedious.
- dbatten 9y ago
  It's further concerning that he appears to have written his own example code for the speculative dark patterns, presenting it alongside real code from insurer websites, which I found misleading at best and downright deceptive at worst...
  - JohnStudio 9y ago
    ... at best.
  - philipodonnell 9y ago
    And then, like, criticize the code quality it as if it came from them for design choices that _the author_ made? > So, my laugh cry scenario here is that they statistically set/just have variables in the code base that say claims spanning a certain amount of time are denied. E.g. WTF, you wrote that code!
    - bringtheaction 9y ago
fortythirteen 9y ago
Never attribute to maliciousness that which can be explained with incompetence. Since two of the three are complete speculation, without any evidence, I'll address the first example. "suppress empty div" could mean that it is hiding an element until a condition in the form is met. You need to see the accompanying JS to understand any intent. It's entirely possible that bad programming is keeping the div both empty and suppressed.
- davidkuhta 9y ago
  "Hanlon's Razor" for those interested: https://en.wikipedia.org/wiki/Hanlon%27s_razor https://en.wikipedia.org/wiki/Hanlon%27s_razor
  - deleted 9y ago
    [deleted]
- jasonkostempski 9y ago
  Even if the exact issues aren't by design, I have absolutely no doubt that the competent person that hired incompetent programmers to ensure policy holders have no idea what they're signing up for or how to make a claim was very much a premeditated malicious maneuver. Bonuses for them are cheap workers and scapegoats for when they piss off the wrong people.
  - fortythirteen 9y ago
    Having worked in equally despised and bureaucratic industries, and with HIPAA, I can assure you that the chances of that are very slim. Purposeful blocking of claim submission would mean millions of dollars in fines for an insurance company. Nobody is actively trying to bring that upon their department. Bureaucratic systems like health insurance are about preserving your position as having the most benefit with the least amount of responsibility. They are ecosystems of mediocrity. A VP at an insurance company generally cares about two things, balance sheets that make him/her look like they're doing a good job and tomorrow's tee time. Directors care about their line on the balance sheet pleasing the VP. That's how you get most insurance company software written by low-wage, visa workers, who could care less about code quality or maintainability, because they'll be at a new gig within a year or two.
cfelix 9y ago
I worked with health insurance as a software developer (in Brazil so maybe it's all different, but still) and here are my observations. 1. Making claim submission impossible He said he tried to submit a claim at the last minute. I believe the hidden page was just lazy work, because the page has to be visible again soon. If they hid the page at an appropiate time I don't know. 2. Routinely denying claim submissions As far as I can tell, in Brazil a regulated health insurance plan can't deny you service based on how many claims of a certain kind you submited. They could before. But the industry will find other ways to not lose money. Readjust prices based on number claims (from all users), prevent you from entering the plan and making a claim right away, pay for a quota of every procedure you take. All these mechanisms already existed, but if they can't deny claims anymore they will tweak the other points. 3. Saying the customer has other insurance This is fucked up. I can't find a explanation that isn't malicious. Here is one similar case that happens in Brazil though. If you have health insurance and use the free health insurance (SUS). The Union will charge back your plan, not you. It's their job to sort it out not yours.
- gcb0 9y ago
  comparing brazil with the US on health insurance and worker rigths is a joke, you know that, rigth? even with the latest illegitimate corrupt government killing most of the work laws last couple months, its still way ahead of the US.
  - cfelix 9y ago
    I know but I still think the points 1 and 2 are pretty much the same for both countries.
JohnStudio 9y ago
My spidey sense in law has to ask myself, "I wonder if that's HIPAA compliant" lol. Should just call it the Dark HIPAA requirements and un-UX in Health Insurance. Laughing aside, the real data pinch in HI is the meta data of the meta data. Once you understand the abstracted layer there, the rest is following EDI compliance contracts and creating views appropriate to the end user. It's a slippery slope.
bawana 9y ago
Insurance companies give me 90 days to submit a claim, then they do not have to pay it. I guess their rationale is that if I did not bother to submit an invoice, then why should they pay? And by the way, a lot of them will not accept paper claims any more. They want all the claims done electronically through their ancient systems. And by the way, this push for electronic medical records(EMR) was a way for them to further decrease their overhead (thank you insurance lobbies). EMR that is CCHIT certified (= Certification Commission for Health Information Technology, pronounounced 's-h-i-t', for real) can interface with payment clearing houses directly (I as a physician have to pay to use a clearing house, btw). Then the claims are scrubbed by their scripts and rejected for various reasons, (for example, no referral from PCP, invalid gender for treatment code,etc). No humans involved. This allows them to lay off vast swaths of auditors. And effectively outsources their work onto the physician's office. And increases their earnings per share. Now you know why the only new physicians you will meet are not homegrown anymore. It costs 400k to go to medical school. Then you have 3-7 years of postgraduate training at 35k a year. Then your debt has ballooned to 800k with deferred interest payments. BTW, new physicians get paid 90-100k.
- pc86 9y ago
  The new physicians making $90k a year after residency are not the ones with $400,000 in student loans, and $800k in total student interest load is... atypical, to say the least. $300-400k total load post-residency is much more - I refuse to say "reasonable," but much more realistic. And the folks who have $400k total load are on a fast track to make $250-300k/yr just a few years after residency. A huge part of why doctors are paid as well as they are is because of the risk and the massive opportunity cost of getting an MD and going into practice. Yes, it takes planning and dedication to set yourself up on solid financial footing post-medical school, and it's entirely conceivable to be in your early thirties before you're debt free. But it's pretty damn hard to be struggling financially as a physician in any field.
  - bawana 9y ago
    there is no 'reason' as to why physicians are paid what they are paid. It's simply supply and demand. A typical physician has to care for 5000 patients a year (that is the size of a full panel, btw) and gets 150k a year. Do the math - 20 patients a day, 5 days a week for 50 weeks a year is 5000 new visits. BTW, phone calls are not billable hourz. Oh, and I forgot 'emergencies' like aunt jemima who has severe burning when she pees, etc and needs to be seen ASAP or else she's going to the ER. Now add in the follow ups and emergencies and you're up to 35 patients a day. If you work for 8 hours (no lunch or breaks) that's 4 patients an hour. But wait, you have to enter patient info into an emr while you're supposed to be talking to the patient. Maybe you need to sip some water and go to the bathroom too. So that's 10 min a patient. for 150k a year. Instead, most MDs are looking to become 'boutique' docs. Each patient pays $2k a year for as much primary care as he/she wants. The boutique doc limits his panel to 500 patients. He makes 6x the money for 1/10 the work. now the doctor can spend an hour with each patient and treat him like a human being instead of a slab of meat. And cut the expensive insurance middleman out of the picture. So right, who needs the stress and bs that comes with a corporate existence. Why should the people who do the work (programmers and coders in your case perhaps) support the wasted busy work of people who are corporate drones and never actually interface with customers/patients/clients/aka the people who pay the money.
beat 9y ago
This is a classic case of attributing the results of stupidity to malice. Insurance companies are heavily regulated and subject to massive fines and public embarrassment for things like deliberately preventing the insured from filing claims. And this sort of petty detail in the UI, being directed from C-level executive management? It doesn't pass the smell test. They're managers, not supervillains. No, this is just garden-variety incompetence. This is the result of incredibly complex specs being implemented by teams of dozens or hundreds, including offshore work and highly distributed teams. The kind of evil plots suggested here would be passing through not just executives, but architects, product owners, scrum masters, lead engineers, and the delightfully unpredictable hands of the cheapest programmers money can buy. Dozens of opportunities for sabotage of something so overtly evil. I've worked in insurance IT quite a bit. They're just not smart enough to do this.
- wnevets 9y ago
  >This is the result of incredibly complex specs being implemented by teams of dozens or hundreds, including offshore work and highly distributed teams. The kind of evil plots suggested here would be passing through not just executives, but architects, product owners, scrum masters, lead engineers, and the delightfully unpredictable hands of the cheapest programmers money can buy. Perhaps that is the evil plan working as intended
  - ixtli 9y ago
    Yeah I mean the fact is that revenue comes from people not collecting benefits.
    - beat 9y ago
      Nope. The vast majority of benefits are processed without incident or complexity, between the medical provider and the insurer, with no action required by the insured. Rigging some UI for hand-entry of claims in a way that suppresses only some, but not all? That's not going to make an appreciable difference in the bottom line.
deleted 9y ago
[deleted]
y3sh 9y ago
United Healthcare... no surprised!
h_i_t 9y ago
beat's post is correct. This is straight up incompetence and just another symptom of how bad things are in Health Care Software right now. To give more background I'll tell you that I work in a company that builds software for major state-wide US insurance companies. Our software touches hundreds of thousands of lives on a daily basis. The problems you're seeing may not even be a part of our software even though our software will do the heavy lifting. Each Health Care customer hosts their own product, although in recent times this is changing thank god. This means they maintain their infrastructure apply patches, manage their network, do their own provisioning, etc, etc. This also means if a manager has the bright idea to $save money$ and build their own in house customer facing claim submission portal we don't know about it. How can we open our software up to work with their shitty portal if we don't even know it exists? It may be harsh to assume the portal is shitty and has bugs like you experienced in item 1 but it really is a safe guess. Most of these US based companies are staffed by workers in India. These workers in India have a long list of obstructions preventing them for doing their job properly: a) 8am on the US Eastern seaboard is 6:30pm in Noida, India. So they're all basically working the night shift. b) Lack of strong labor laws or fair compensation. High turnover in a critical IT field is bad, bad, bad. I've gotten calls from people in India who are trying to find out who their manager is in the US. I don't know bro I'm just a vendor :(. c) A handful of non-technical, non-healthcare business folks managing a team of people on the other side of the world is a recipe for pain and failure. Here's a great example of the mysterious cause behind "Rising Medical Care Costs". d) Lack of training and proper communication leads to horrible awful undocumented software abominations. I am borderline willing to blame my balding on these troubleshooting calls. What I'm trying to make clear is that the failure may be between some shitty interface Insurance Co. #1234 built to save money. If that's the case it'll never really get fixed as the people managing it may not even be aware of the bug. If all goes well and the interface to our Insurance software is actually correct then "Hooray!" your customer facing bug gets to someone like me! Now we've entered the realm of a US based software company. But our service that processes this information is 12 years old, the ONE guy who built it in the 90s is long gone, and there's no documentation. So good luck getting someone to take ownership of that. That's assuming I can even reproduce the bug. Reproducing the bug may be an odyssey wholly unto itself. It might take 3 developers and 1 QA engineer that has 20 years of seniority to figure out why logging isn't working for this 12 year old service. So that's your dark pattern. It is more of business pattern but its a pattern that has so far caught every god damn piece of Health Care software in its net.

203 points by luu 9y ago

Im disappointed to confirm these are quite real. I've seen a particular case where a benefits enrollment page has a check box list where your selected enrollments at the top of the page _silently change as you edit fields near the bottom_. And you can bet which direction those values change. It doesnt hide a submission button like the author's example but it DOES prey on those who neglect to review their submission in full before continuing (which I guarantee is a significant and quantifiable benefit to the payer) It's a big stretch of the imgaination to dismiss this behavior as 'designer error'. This is a great example of where class action lawsuits can and should be employed.

fnordsensei 9y ago

Let's forget ethics for a moment, is there any decent way to calculate the difference in bottom line between creating and providing a great service (presumably leading to a good reputation, and maybe better, more long-lasting relationships with customers), and squeezing and weaseling every penny out of your customers and doing everything in your power to keep them from using the service they bought (presumably leading to bad reputation, but more cash upfront)? In some industries/companies/communities/what-have-you, there seems to be this consensus that exploitation, scamming and backstabbing is the obvious way to make the big bucks. Is this objectively true, or is it just some kind of oral history and tradition handed down from 1800s industrialists?

laurent123456 9y ago
One thing they could do is assign a score to each insuree (and I guess they already do something like this) based on the number of past claims and likelihood there will be more. Depending on that score they present more or less dark UI patterns to that user. Past a certain threshold they probably don't want to keep the insuree anyway, so if they switch it's still good for the insurer. They can calculate the likelihood the user will switch and how much the insurer will lose in premium, versus how much they'll win if they delay claims as much as possible.
- taneq 9y ago
  I'm pretty sure "vary your evilness based on how much you think someone's worth to you" is an evil pattern. :P
  - gergles 9y ago
    That may be, but it's still incredibly common. Look up the concept of LTV. I have personal experience in customer service scenarios where people classed by 'the computer' with an LTV score below a certain value were not to be retained if they wanted to cancel our service (c.f. for a higher level LTV customer we might offer a promotion or something) and people with a score even lower were to be actively encouraged to leave if they reported any problems - even to the point where we were supposed to suggest they try somebody else rather than spending any time fixing their problems. Granted, these were (allegedly) people who were actively costing the company money in that it cost more to service their account than the revenue they provided, but it was an automated decision made by an algorithm that the phone and retail reps just had to enforce.
zer0t3ch 9y ago
I think that's pretty heavily reliant on the rest of the industry. If it's an industry that no one feels very strongly about, there's probably something to be said for hanging out in the middle: some scummy shit, but no nickle and diming. If it's something significant where every company is hated already, a new company coming in with nothing more than "we want nothing more than to provide a good service" is likely going to thrive.
- twobyfour 9y ago
  That assumes the customer is the one who chooses. With most Americans getting insurance through their employers, they don't have the option to choose a less crappy insurer even if they trusted the claims of better service.
kiliantics 9y ago
If you don't resort to the weaseling, then you lose out to the competition. Capitalism is a system which naturally selects for the most scammy actors to survive and thrive.
- ams6110 9y ago
  Your comment makes no sense. Do you as a customer seek out the most scammy companies to do business with?
  - kiliantics 9y ago
    Sometimes, there are only scammy businesses left, after they have out-competed any alternatives through dirty tactics that their competitors refused to resort to.
    - fnordsensei 9y ago
      But then the non-scammy should have a business opportunity in breaking the status quo.
hvindin 9y ago
I would question the incentives for an insurance company to reject claims arbitrarily or to not make the process for submitted claims at the very least adequate for two reasons: 1. If you insure a bunch of people against, in short, stuff that can kill them, then it's really in your best financial interests to be making sure that as many of those people as possible are seeing a doctor as regularly as possible (within reason) because that's how you avoid situations where someone makes shitty healthcare decisions for 3 decades then suddenly needs every imaginable treatment for every imaginable ailment that said person, who is obviously not a healthcare professional, would have never seen coming because they weren't regularly attending to their health in a low cost consistent kind of way, instead they just let their health deteriorate until it was an emergency. Which, from my understanding, especially in America, is where the vultures pounce to ensure your insurance companies pays top dollar for critical drugs and treatment. 2. On a purely accounting note, wouldn't this just fuck up your cash flow figures? I mean, if someone needs to get their insurer to pay for something because they don't have another option and they try and claim for that thing, isn't it in your best interest to make sure you pay out the amount at least reasonably quickly because, especially if you're acting in bad faith, their going to eventually break their way through the system to the "submit claim button" through sheer hours of trying, or their going to end up in court because they don't have other options. Then you've suddenly got a massive lump sum payout that probably wasn't in your forecasted expenses. To me, that just sounds like unpredictable silliness. But then again, I live in a country with free health insurance so I genuinely could be entirely missing the mark here and it could genuinely be more profitable to pinch your pennies as an insurer.
- comatose 9y ago
  It doesn't necessarily follow that the most profitable path will be taken by middle managers, they often have perverse incentives, real or imagined, to cut costs short term even when the company would be better off if the insured stay healthy!
bbddg 9y ago
I think for most insurers it's more profitable to provide less service and preventative care for two specific reasons. One, once a person is 65 they are covered by Medicare and are the government's problem. Two, if someone under 65 does get seriously sick or injured, chances are they're going to have to leave their job or get fired. With most people getting insurance through work, the insurance company isn't on the hook anymore either.
- nradov 9y ago
  The ACA required most health plans to provide free preventive health services. https://www.healthcare.gov/coverage/preventive-care-benefits/ https://www.healthcare.gov/coverage/preventive-care-benefits...

hanklazard 9y ago

Not a dark UX, but another move I’ve seen that is line with the stall-for-time method that the author mentions is the requirement for a prior authorization, even for very common medicines. I have seen first-hand the amount of work this tactic creates in medical offices. It definitely allows insurance companies to stall in their approval/payment for medicines and, I’m sure in a % of cases, not pay at all (ie, the paperwork doesn’t get completed, patient gives up trying to navigate the complexity of the system).

jimktrains2 9y ago
My most hated is "The thing your doctor did was not medically necessary, therefore we won't cover it."

panic 9y ago

Meanwhile, these insurance companies are making billions of dollars of profit (https://www.axios.com/profits-are-booming-at-health-insurance-companies-1513302495-18f3710a-c0b4-4ce3-8b7f-894a755e6679.html https://www.axios.com/profits-are-booming-at-health-insuranc...). There's no reason insurance companies need to be involved in health care at all.

Ntrails 9y ago
> There's no reason insurance companies need to be involved in health care at all. As a Brit I sort of agree, because I think free healthcare at point of delivery is the right solution. However the more continental model works perfectly well and many countries use private insurers for that sort of model. Insurance companies have a lot of expertise in risk management, analysis and costing so to claim that they've no place in healthcare is odd.
- beat 9y ago
  Getting far afield here, but... there's something uniquely broken about the financial model of the US system. Pretty much every industrialized nation in the world pays about half as much per capita as the US does for its health care, and pretty much all of them provide universal coverage. And this is everyone, from purely socialist systems to mostly private systems. Which is why I have issues with both the right-wing insistence that nothing is wrong with ours that a little more free market can't cure, and the left-wing insistence that only a purely socialist single payer system will provide financial responsibility and social justice.
ams6110 9y ago
Billions of profit out of trillions spent on health care. Insurance company profits are not the real problem with health care costs.
- shkkmo 9y ago
  Insurance profits seems to make up only about 1% of our total private healthcare expenditures. However, that doesn't take into account the amount of those healthcare expenditures that are being spent to generate those profits rather than to provide healthcare. It also doesn't account for the additional costs to non-insurers from systemic problems created and maintained insurers to increase their profits. (E.G. pushing filing/approval costs onto physician's offices or systemically fixing prices). So while Insurance company profits are not the direct cause of the outlandish healthcare costs in the US, they are a huge contributor to our problem and a core driver for many of it's multitudinous factors.

jawns 9y ago

This post lists three examples of dark algs/UX. However, the second and third examples are speculative. They might be a result of an algorithm, or they might be a result of stupid policies, or they might be a result of operational errors. Who knows? Alleging that it's a "dark algorithm" sounds cool, but it isn't really damning without evidence. So we're down to one example of actual dark UX, which doesn't make for a particularly strong allegation. I wish the author had taken just a little more time before publishing to collect a few other authentic examples. That said, I know from my own experience that health insurers' online portals tend to have horrible UX, because it is not in their best interest to have great UX. Just yesterday, I had to fill out a form indicating that none of the five members of my household had other insurance or were Medicaid-eligible. There were a total of 10 checkboxes I had to check. After checking each one, I got a loading indicator and then the page refreshed, so I had to scroll the page back down to the next checkbox. It didn't prevent me from filling in the information, but it definitely made it needlessly tedious.

dbatten 9y ago
It's further concerning that he appears to have written his own example code for the speculative dark patterns, presenting it alongside real code from insurer websites, which I found misleading at best and downright deceptive at worst...
- JohnStudio 9y ago
  ... at best.
- philipodonnell 9y ago
  And then, like, criticize the code quality it as if it came from them for design choices that _the author_ made? > So, my laugh cry scenario here is that they statistically set/just have variables in the code base that say claims spanning a certain amount of time are denied. E.g. WTF, you wrote that code!
  - bringtheaction 9y ago

fortythirteen 9y ago

Never attribute to maliciousness that which can be explained with incompetence. Since two of the three are complete speculation, without any evidence, I'll address the first example. "suppress empty div" could mean that it is hiding an element until a condition in the form is met. You need to see the accompanying JS to understand any intent. It's entirely possible that bad programming is keeping the div both empty and suppressed.

davidkuhta 9y ago
"Hanlon's Razor" for those interested: https://en.wikipedia.org/wiki/Hanlon%27s_razor https://en.wikipedia.org/wiki/Hanlon%27s_razor
- deleted 9y ago
  [deleted]
jasonkostempski 9y ago
Even if the exact issues aren't by design, I have absolutely no doubt that the competent person that hired incompetent programmers to ensure policy holders have no idea what they're signing up for or how to make a claim was very much a premeditated malicious maneuver. Bonuses for them are cheap workers and scapegoats for when they piss off the wrong people.
- fortythirteen 9y ago
  Having worked in equally despised and bureaucratic industries, and with HIPAA, I can assure you that the chances of that are very slim. Purposeful blocking of claim submission would mean millions of dollars in fines for an insurance company. Nobody is actively trying to bring that upon their department. Bureaucratic systems like health insurance are about preserving your position as having the most benefit with the least amount of responsibility. They are ecosystems of mediocrity. A VP at an insurance company generally cares about two things, balance sheets that make him/her look like they're doing a good job and tomorrow's tee time. Directors care about their line on the balance sheet pleasing the VP. That's how you get most insurance company software written by low-wage, visa workers, who could care less about code quality or maintainability, because they'll be at a new gig within a year or two.

cfelix 9y ago

I worked with health insurance as a software developer (in Brazil so maybe it's all different, but still) and here are my observations. 1. Making claim submission impossible He said he tried to submit a claim at the last minute. I believe the hidden page was just lazy work, because the page has to be visible again soon. If they hid the page at an appropiate time I don't know. 2. Routinely denying claim submissions As far as I can tell, in Brazil a regulated health insurance plan can't deny you service based on how many claims of a certain kind you submited. They could before. But the industry will find other ways to not lose money. Readjust prices based on number claims (from all users), prevent you from entering the plan and making a claim right away, pay for a quota of every procedure you take. All these mechanisms already existed, but if they can't deny claims anymore they will tweak the other points. 3. Saying the customer has other insurance This is fucked up. I can't find a explanation that isn't malicious. Here is one similar case that happens in Brazil though. If you have health insurance and use the free health insurance (SUS). The Union will charge back your plan, not you. It's their job to sort it out not yours.

gcb0 9y ago
comparing brazil with the US on health insurance and worker rigths is a joke, you know that, rigth? even with the latest illegitimate corrupt government killing most of the work laws last couple months, its still way ahead of the US.
- cfelix 9y ago
  I know but I still think the points 1 and 2 are pretty much the same for both countries.

JohnStudio 9y ago

My spidey sense in law has to ask myself, "I wonder if that's HIPAA compliant" lol. Should just call it the Dark HIPAA requirements and un-UX in Health Insurance. Laughing aside, the real data pinch in HI is the meta data of the meta data. Once you understand the abstracted layer there, the rest is following EDI compliance contracts and creating views appropriate to the end user. It's a slippery slope.

bawana 9y ago

Insurance companies give me 90 days to submit a claim, then they do not have to pay it. I guess their rationale is that if I did not bother to submit an invoice, then why should they pay? And by the way, a lot of them will not accept paper claims any more. They want all the claims done electronically through their ancient systems. And by the way, this push for electronic medical records(EMR) was a way for them to further decrease their overhead (thank you insurance lobbies). EMR that is CCHIT certified (= Certification Commission for Health Information Technology, pronounounced 's-h-i-t', for real) can interface with payment clearing houses directly (I as a physician have to pay to use a clearing house, btw). Then the claims are scrubbed by their scripts and rejected for various reasons, (for example, no referral from PCP, invalid gender for treatment code,etc). No humans involved. This allows them to lay off vast swaths of auditors. And effectively outsources their work onto the physician's office. And increases their earnings per share. Now you know why the only new physicians you will meet are not homegrown anymore. It costs 400k to go to medical school. Then you have 3-7 years of postgraduate training at 35k a year. Then your debt has ballooned to 800k with deferred interest payments. BTW, new physicians get paid 90-100k.

pc86 9y ago
The new physicians making $90k a year after residency are not the ones with $400,000 in student loans, and $800k in total student interest load is... atypical, to say the least. $300-400k total load post-residency is much more - I refuse to say "reasonable," but much more realistic. And the folks who have $400k total load are on a fast track to make $250-300k/yr just a few years after residency. A huge part of why doctors are paid as well as they are is because of the risk and the massive opportunity cost of getting an MD and going into practice. Yes, it takes planning and dedication to set yourself up on solid financial footing post-medical school, and it's entirely conceivable to be in your early thirties before you're debt free. But it's pretty damn hard to be struggling financially as a physician in any field.
- bawana 9y ago
  there is no 'reason' as to why physicians are paid what they are paid. It's simply supply and demand. A typical physician has to care for 5000 patients a year (that is the size of a full panel, btw) and gets 150k a year. Do the math - 20 patients a day, 5 days a week for 50 weeks a year is 5000 new visits. BTW, phone calls are not billable hourz. Oh, and I forgot 'emergencies' like aunt jemima who has severe burning when she pees, etc and needs to be seen ASAP or else she's going to the ER. Now add in the follow ups and emergencies and you're up to 35 patients a day. If you work for 8 hours (no lunch or breaks) that's 4 patients an hour. But wait, you have to enter patient info into an emr while you're supposed to be talking to the patient. Maybe you need to sip some water and go to the bathroom too. So that's 10 min a patient. for 150k a year. Instead, most MDs are looking to become 'boutique' docs. Each patient pays $2k a year for as much primary care as he/she wants. The boutique doc limits his panel to 500 patients. He makes 6x the money for 1/10 the work. now the doctor can spend an hour with each patient and treat him like a human being instead of a slab of meat. And cut the expensive insurance middleman out of the picture. So right, who needs the stress and bs that comes with a corporate existence. Why should the people who do the work (programmers and coders in your case perhaps) support the wasted busy work of people who are corporate drones and never actually interface with customers/patients/clients/aka the people who pay the money.

beat 9y ago

This is a classic case of attributing the results of stupidity to malice. Insurance companies are heavily regulated and subject to massive fines and public embarrassment for things like deliberately preventing the insured from filing claims. And this sort of petty detail in the UI, being directed from C-level executive management? It doesn't pass the smell test. They're managers, not supervillains. No, this is just garden-variety incompetence. This is the result of incredibly complex specs being implemented by teams of dozens or hundreds, including offshore work and highly distributed teams. The kind of evil plots suggested here would be passing through not just executives, but architects, product owners, scrum masters, lead engineers, and the delightfully unpredictable hands of the cheapest programmers money can buy. Dozens of opportunities for sabotage of something so overtly evil. I've worked in insurance IT quite a bit. They're just not smart enough to do this.

wnevets 9y ago
>This is the result of incredibly complex specs being implemented by teams of dozens or hundreds, including offshore work and highly distributed teams. The kind of evil plots suggested here would be passing through not just executives, but architects, product owners, scrum masters, lead engineers, and the delightfully unpredictable hands of the cheapest programmers money can buy. Perhaps that is the evil plan working as intended
- ixtli 9y ago
  Yeah I mean the fact is that revenue comes from people not collecting benefits.
  - beat 9y ago
    Nope. The vast majority of benefits are processed without incident or complexity, between the medical provider and the insurer, with no action required by the insured. Rigging some UI for hand-entry of claims in a way that suppresses only some, but not all? That's not going to make an appreciable difference in the bottom line.

deleted 9y ago

[deleted]

y3sh 9y ago

United Healthcare... no surprised!

h_i_t 9y ago

beat's post is correct. This is straight up incompetence and just another symptom of how bad things are in Health Care Software right now. To give more background I'll tell you that I work in a company that builds software for major state-wide US insurance companies. Our software touches hundreds of thousands of lives on a daily basis. The problems you're seeing may not even be a part of our software even though our software will do the heavy lifting. Each Health Care customer hosts their own product, although in recent times this is changing thank god. This means they maintain their infrastructure apply patches, manage their network, do their own provisioning, etc, etc. This also means if a manager has the bright idea to $save money$ and build their own in house customer facing claim submission portal we don't know about it. How can we open our software up to work with their shitty portal if we don't even know it exists? It may be harsh to assume the portal is shitty and has bugs like you experienced in item 1 but it really is a safe guess. Most of these US based companies are staffed by workers in India. These workers in India have a long list of obstructions preventing them for doing their job properly: a) 8am on the US Eastern seaboard is 6:30pm in Noida, India. So they're all basically working the night shift. b) Lack of strong labor laws or fair compensation. High turnover in a critical IT field is bad, bad, bad. I've gotten calls from people in India who are trying to find out who their manager is in the US. I don't know bro I'm just a vendor :(. c) A handful of non-technical, non-healthcare business folks managing a team of people on the other side of the world is a recipe for pain and failure. Here's a great example of the mysterious cause behind "Rising Medical Care Costs". d) Lack of training and proper communication leads to horrible awful undocumented software abominations. I am borderline willing to blame my balding on these troubleshooting calls. What I'm trying to make clear is that the failure may be between some shitty interface Insurance Co. #1234 built to save money. If that's the case it'll never really get fixed as the people managing it may not even be aware of the bug. If all goes well and the interface to our Insurance software is actually correct then "Hooray!" your customer facing bug gets to someone like me! Now we've entered the realm of a US based software company. But our service that processes this information is 12 years old, the ONE guy who built it in the 90s is long gone, and there's no documentation. So good luck getting someone to take ownership of that. That's assuming I can even reproduce the bug. Reproducing the bug may be an odyssey wholly unto itself. It might take 3 developers and 1 QA engineer that has 20 years of seniority to figure out why logging isn't working for this 12 year old service. So that's your dark pattern. It is more of business pattern but its a pattern that has so far caught every god damn piece of Health Care software in its net.