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> Even when users successfully appealed these AI-generated determinations and win, they’re greeted with follow up AI-dictated rejections just days later, starti

> Even when users successfully appealed these AI-generated determinations and win, they’re greeted with follow up AI-dictated rejections just days later, starting the process all over again. Wait, what? Does that mean they can just take your money and reject your request to cover treatment until you die even if you had every right to do so?

manicennui 3y ago
Yes, this is what Americans mean when they parrot bullshit about freedom: the freedom for corporations to do whatever they like in pursuit of profit.
- cryptonector 3y ago
  We don't have a free market in healthcare in the U.S. though. You can be for a free market and against the abomination we currently have. If we just went back to 80%/20%, high-premium-or-high-deductible proper insurance, no HMOs, no PPOs, no co-pays, none of that nonsense, with published pricing, then we'd have a free market.
  - sofixa 3y ago
    Is the regulations that are forcing co-pays, networks, obscured pricing? From the outside it sounds like the market doing it's best to extract as much money as possible, with the occasional regulation designed to look like someone is trying to fix the mess with a pretty bandaid (like the recent one on detailed upfront pricing).
    - cryptonector 3y ago
      ERISA started the ball by making it employers' responsibility to provide healthcare for employees, and then more "reforms". These things led to the current sorry state of healthcare in the U.S.
  - manicennui 3y ago
    Thanks for proving my point.
  - mindslight 3y ago
    I'm all for reforms to move towards a more market based system. But one has to recognize that at this point we're nearing a century of anti-market meddling - a quick search says 1943 is when healthcare started getting bundled with employment! And talking about a "free" market is a red herring. There's no reason to believe that the current industry actually wishes to converge on uniform prices with upfront transparency - they could just start publishing such prices at any time currently, but rather continue to benefit from heavy price discrimination. So getting to a functioning healthcare market would actually take a lot of regulation that actively undoes the cancerous behemoth that's been slowly grown. Try asking any doctor how much something might cost and most of the time they will scoff - the rejection of any market dynamics has become pervasive by the entire system. Also to have an actual free market we'd need to eliminate things like mandatory pharmaceutical prescriptions and patents, which there is unfortunately very little support for doing.
    - cryptonector 3y ago
      > And talking about a "free" market is a red herring. There's no reason to believe that the current industry actually wishes to converge on uniform prices with upfront transparency [...] Adam Smith himself noted that capitalists seek rent. That doesn't mean that capitalism is all bad. The healthcare industry almost certainly does not want a free market, but so what, it's about whether the state makes it so there's a free market anyways or else makes deals with the industry it ought to regulate. Regulatory capture is a thing, a very real thing, and a very big deal. > Also to have an actual free market we'd need to eliminate things like mandatory pharmaceutical prescriptions and patents, which there is unfortunately very little support for doing. Patents are not the problem. Though I'd be happy to see patent terms shortened, especially for software patents.
      - mindslight 3y ago
        I didn't say "capitalism is bad". I pointed out that the state of the current market players are so far from what you'd expect in a "free" market, that pushing to make the market incrementally more free is likely to do the exact opposite by increasing the coercive powers of the already-entrenched interests. Once the health "insurance" cartels are put out of business, providers are legally required to publish uniform price schedules and ahead of time quotes, pharmaceuticals can be freely bought across borders, mandatory prescriptions are eliminated, residencies are funded privately, etc, then maybe there is a chance at a freed market fostering a functioning market. But not one step before then.
- mcosta 3y ago
  Isn't the medical field one of the most regulated?
  - __loam 3y ago
    The answer is not less regulation, it's to have publicly owned healthcare. Those regulations were written in blood. Also go listen to one of the latest episodes of Odd Lots where they interview Lena Khan about anti-trust. Private equity has been rolling up medical companies for decades, essentially doing things like buying up all the anesthesiology clinics in an area so they can jack up prices. Some of the bloat is due to regulations but a lot of the bloat is due to over-financialized bullshit like private equity buying up providers.
TheCleric 3y ago
Unless you have expertise in fighting them, yes. https://www.propublica.org/article/blue-cross-proton-therapy-cancer-lawyer-denial https://www.propublica.org/article/blue-cross-proton-therapy...
dsaavy 3y ago
Yep, and ever since a certain insurance provider has switched to an AI system, I've had nearly all my Type 1 Diabetic prescriptions rejected (that I've had no problem getting for over a decade). Then it takes hours on the phone for every prescription to finally get one approved. Rinse and repeat every 3 months.
- sofixa 3y ago
  This is inhumane.
- hotnfresh 3y ago
  We’ve had a flex spending account (HSA wasn’t an option) that we were only putting as much in as we were sure we’d spend, rejecting a very high rate of payments this year, even from doctor’s offices (WTF do you think that’s for?!) and demanding documentation, seemingly with no rhyme or reason. Seems like they’re actively trying to keep us above the roll-over limit so they can steal our money, which isn’t something we’ve experienced with health flex accounts in the past. Wonder if we’re “beneficiaries” of the AI revolution. Or just an “if” statement triggering off a random number.
  - dsaavy 3y ago
    I agree, sounds like their systems are optimizing based on the roll-over limit. Basically I'm just going back to cash pay and negotiation for everything either before the visit, or at the facility. Then using alternatives to health insurance for the original purpose of insurance (lol), to cover unexpected events.
rqtwteye 3y ago
Technically no, but you need to be able to afford paying for lawyers to fight them or spend an enormous amount of time and energy. For some reason health insurances and hospitals can get away with practices that no other business would get away with. They can commit fraud and when they get caught, all they have to do is to say "oops" and fix the mistake. No other consequences. It's pretty crazy

manicennui 3y ago

Yes, this is what Americans mean when they parrot bullshit about freedom: the freedom for corporations to do whatever they like in pursuit of profit.

cryptonector 3y ago
We don't have a free market in healthcare in the U.S. though. You can be for a free market and against the abomination we currently have. If we just went back to 80%/20%, high-premium-or-high-deductible proper insurance, no HMOs, no PPOs, no co-pays, none of that nonsense, with published pricing, then we'd have a free market.
- sofixa 3y ago
  Is the regulations that are forcing co-pays, networks, obscured pricing? From the outside it sounds like the market doing it's best to extract as much money as possible, with the occasional regulation designed to look like someone is trying to fix the mess with a pretty bandaid (like the recent one on detailed upfront pricing).
  - cryptonector 3y ago
    ERISA started the ball by making it employers' responsibility to provide healthcare for employees, and then more "reforms". These things led to the current sorry state of healthcare in the U.S.
- manicennui 3y ago
  Thanks for proving my point.
- mindslight 3y ago
  I'm all for reforms to move towards a more market based system. But one has to recognize that at this point we're nearing a century of anti-market meddling - a quick search says 1943 is when healthcare started getting bundled with employment! And talking about a "free" market is a red herring. There's no reason to believe that the current industry actually wishes to converge on uniform prices with upfront transparency - they could just start publishing such prices at any time currently, but rather continue to benefit from heavy price discrimination. So getting to a functioning healthcare market would actually take a lot of regulation that actively undoes the cancerous behemoth that's been slowly grown. Try asking any doctor how much something might cost and most of the time they will scoff - the rejection of any market dynamics has become pervasive by the entire system. Also to have an actual free market we'd need to eliminate things like mandatory pharmaceutical prescriptions and patents, which there is unfortunately very little support for doing.
  - cryptonector 3y ago
    > And talking about a "free" market is a red herring. There's no reason to believe that the current industry actually wishes to converge on uniform prices with upfront transparency [...] Adam Smith himself noted that capitalists seek rent. That doesn't mean that capitalism is all bad. The healthcare industry almost certainly does not want a free market, but so what, it's about whether the state makes it so there's a free market anyways or else makes deals with the industry it ought to regulate. Regulatory capture is a thing, a very real thing, and a very big deal. > Also to have an actual free market we'd need to eliminate things like mandatory pharmaceutical prescriptions and patents, which there is unfortunately very little support for doing. Patents are not the problem. Though I'd be happy to see patent terms shortened, especially for software patents.
    - mindslight 3y ago
      I didn't say "capitalism is bad". I pointed out that the state of the current market players are so far from what you'd expect in a "free" market, that pushing to make the market incrementally more free is likely to do the exact opposite by increasing the coercive powers of the already-entrenched interests. Once the health "insurance" cartels are put out of business, providers are legally required to publish uniform price schedules and ahead of time quotes, pharmaceuticals can be freely bought across borders, mandatory prescriptions are eliminated, residencies are funded privately, etc, then maybe there is a chance at a freed market fostering a functioning market. But not one step before then.
mcosta 3y ago
Isn't the medical field one of the most regulated?
- __loam 3y ago
  The answer is not less regulation, it's to have publicly owned healthcare. Those regulations were written in blood. Also go listen to one of the latest episodes of Odd Lots where they interview Lena Khan about anti-trust. Private equity has been rolling up medical companies for decades, essentially doing things like buying up all the anesthesiology clinics in an area so they can jack up prices. Some of the bloat is due to regulations but a lot of the bloat is due to over-financialized bullshit like private equity buying up providers.

TheCleric 3y ago

Unless you have expertise in fighting them, yes. https://www.propublica.org/article/blue-cross-proton-therapy-cancer-lawyer-denial https://www.propublica.org/article/blue-cross-proton-therapy...

dsaavy 3y ago

Yep, and ever since a certain insurance provider has switched to an AI system, I've had nearly all my Type 1 Diabetic prescriptions rejected (that I've had no problem getting for over a decade). Then it takes hours on the phone for every prescription to finally get one approved. Rinse and repeat every 3 months.

sofixa 3y ago
This is inhumane.
hotnfresh 3y ago
We’ve had a flex spending account (HSA wasn’t an option) that we were only putting as much in as we were sure we’d spend, rejecting a very high rate of payments this year, even from doctor’s offices (WTF do you think that’s for?!) and demanding documentation, seemingly with no rhyme or reason. Seems like they’re actively trying to keep us above the roll-over limit so they can steal our money, which isn’t something we’ve experienced with health flex accounts in the past. Wonder if we’re “beneficiaries” of the AI revolution. Or just an “if” statement triggering off a random number.
- dsaavy 3y ago
  I agree, sounds like their systems are optimizing based on the roll-over limit. Basically I'm just going back to cash pay and negotiation for everything either before the visit, or at the facility. Then using alternatives to health insurance for the original purpose of insurance (lol), to cover unexpected events.

rqtwteye 3y ago

Technically no, but you need to be able to afford paying for lawyers to fight them or spend an enormous amount of time and energy. For some reason health insurances and hospitals can get away with practices that no other business would get away with. They can commit fraud and when they get caught, all they have to do is to say "oops" and fix the mistake. No other consequences. It's pretty crazy