3 ms·

Of the only claims that have been adjudicated 90% were found to have been erroneous. Without analysis there is no particular reason to believe that other denia

Of the only claims that have been adjudicated 90% were found to have been erroneous. Without analysis there is no particular reason to believe that other denials were more justified. Few doctors on average make nonsensical requests for patient care while insurers issue spurious denials as a matter of course. You dont need to know the total number of denials instead you need a neutral party to analyze a random sample of denials. We could do this as matter of course and tie failing an adequate benchmark to ruinous penalties to company and CEO.

hayksaakian 3y ago
I think the OP is suggesting that hypothetically speaking, people would only go through the hassle of appealing if they were pretty sure they would win to begin with
- kelnos 3y ago
  I think that logic is just as faulty as the assumption that 90% of the un-appealed claims would also be overturned. I suspect many people just don't know that they can appeal. Those that do might think it's too difficult to do so, or believe it requires some specialized knowledge to do properly.
  - vikramkr 3y ago
    And this is a perfect example of the type of conversation that happens when the correct answer is that we don't know the answer but everyone keeps talking in circles pretending there's a way to know with any certainty other than testing all (or a carefully chosen random sample) of the other denials and getting the actual data. Whenever there's a disagreement where both sides seem reasonable it means that both sides are wrong because the correct answer is that the information present is inadequate to distinguish. All the potential reasons for things going one way or another are also just hypothesis to test since the gut feeling could be right and the reason wrong, and just getting a percentage on the rest isn't enough to figure out why that percentage is what it is
    - blitzar 3y ago
      > testing all or a carefully chosen random sample of the other denials and getting the actual data We should build an Ai to test this.
      - michaelmrose 3y ago
        Funny.

hayksaakian 3y ago

I think the OP is suggesting that hypothetically speaking, people would only go through the hassle of appealing if they were pretty sure they would win to begin with

kelnos 3y ago
I think that logic is just as faulty as the assumption that 90% of the un-appealed claims would also be overturned. I suspect many people just don't know that they can appeal. Those that do might think it's too difficult to do so, or believe it requires some specialized knowledge to do properly.
- vikramkr 3y ago
  And this is a perfect example of the type of conversation that happens when the correct answer is that we don't know the answer but everyone keeps talking in circles pretending there's a way to know with any certainty other than testing all (or a carefully chosen random sample) of the other denials and getting the actual data. Whenever there's a disagreement where both sides seem reasonable it means that both sides are wrong because the correct answer is that the information present is inadequate to distinguish. All the potential reasons for things going one way or another are also just hypothesis to test since the gut feeling could be right and the reason wrong, and just getting a percentage on the rest isn't enough to figure out why that percentage is what it is
  - blitzar 3y ago
    > testing all or a carefully chosen random sample of the other denials and getting the actual data We should build an Ai to test this.
    - michaelmrose 3y ago
      Funny.