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For-Profit 'Medicare Advantage' Plans Using AI for Denials

• gumballindie 3y ago
  I think ai in health care - and many other fields - is just corporations and the government taking the piss in figuring out how much garbage people will accept until they figure out they are being taken for fools. In the uk you basically cant see a doctor, even in private healthcare, until you chat with some crappy chat bot that does nothing for you. Non medical customer support too. However they do take your money, either through taxes or fees.
• LorenPechtel 3y ago
  The problem isn't in using AI to find things that shouldn't be. The problem is in trusting the results. Current "AI" is really just a glorified autocomplete and thus it's going to return the common answer. Fine if it's a common situation, but it should be *expected* to get it wrong when it's a sufficiently rare situation. 1) Modify the system so the doctors can add notes as to why this isn't the usual situation. Don't make the person doing the approving figure it out. 2) Use AI to find suspect things but have a human review them--and any rejection must explicitly address anything in the notes about how it's unusual. 3) Rejecting a request is treated as a medical decision, requiring the person making it to be qualified to make it and subject to malpractice as if they had failed to recommend it to the patient when seeing them.
• Xorakios 3y ago
  Not sure where Common Dreams got their info from, but my partner is with Humana Medical Advantage last two years and the only bill he ever got was from a city ambulance - everything else for years has been free. My Blue Cross through Obamacare bills me for everything, including 20% of $175 for generic Tylenol when I went to a required annual physical for age 55 and above. AI may have been in the background somewhere, but treatment was by humans, and billing was by hand coded treatment as well