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AI cannot be used to deny health care coverage, feds clarify to insurers
- gipp 3y agoAI has been used to deny healthcare coverage for generations, we just called it actuarial science
- Zetobal 3y agoWhat? I tell my dad that the funny spreadsheets he made in the 60s are AI now.
- Detrytus 3y agoWell, the only significant difference between "funny spreadsheets" and ML models is the size of data you can feed them.
- deleted 3y ago[deleted]
- vitehozonage 3y agoAll regulations involving AI just make me wonder how the hell anyone can draw a line between statistics and whatever ""AI"" means in 2024. Getting angry at the moment every time i see "AI" because the terminology is just nonsense to me. Is it just neural networks now?
- vermarish 3y ago"Statistics" = models with interpretable decision outcomes "AI" = models without It's just a little bit easier to hold someone accountable for a logistic regression with predictive bias than for a neural network with similar issues.
- DistractionRect 3y agoExactly this. Decisions based on statistical models can be fully audited and understood, and the results are reproducible because the algorithm is well documented. The same can't be said of AI models.
- anon373839 3y agoI believe it’s possible with decision trees and forests, even though they’re very complex inside, to calculate the contribution that each independent variable made to the final result. Of course, I suppose those haven’t been deemed “AI” for a few years.
- DistractionRect 3y agoSure, you can step through it and see what's occurring, but there's zero explanation to accompany it. To fully reverse engineer and explain a reasonably complex AI model would be quite the undertaking. Instead, we have prompt engineering. It's easier to figure out how to ask the black box nicely/properly to do what you want than to open it up and optimize/tune it proper. If we assume that we get that far, I fully expect the resulting explanation of the black box internals wouldn't be considered a reasonable/reliable basis for making medical decisions.
- jwilber 3y agoThe explanation is unbelievably straightforward for tree models, even if you don’t fully understand entropy/information gain? What?
- tzs 3y agoAs long as the model is deterministic in operation, even if the process of building the model is non-deterministic, can't decisions be interpreted by rerunning the model with tweaked inputs to find what would be needed to change the outcome? For example suppose a bank rejects a credit application and they need to tell the applicant why. Repeatedly add $1000 to the income input and check again until until the model approves, and then tell the application they were rejected for insufficient income and how much more they would need to pass.
- cyanydeez 3y agoif we can blame a person, it's not AI.
- gumby 3y agoInstead, a physician working for the insurance company will use some sort of GPT to come up with an excuse to deny care and then they will write that up in their own words to deny care.
- RCitronsBroker 3y agoas a med student, those guys are an embarrassment to us all. I had to deal with those guys to get my insurance to cover recombinant antibodies for the treatment of several autoimmune diseases. They haven’t practiced clinically for a decade, haven’t kept up with research ever since they left residency, but still don’t see any problem with denying anything but the cheapest immunosuppressant, no matter how bad the side effects may be. Screw them all, i wish them nothing but the worst
- earthwalker99 3y ago[flagged]
- NPC82 3y agoThe physician who gives legitimacy to denying coverage at an insurance company is at the very heart of what you're complaining about. As the other poster has pointed out, and many physicians online, they are so out of practice and out of touch they basically say whatever the insurance company wants them to for money.
- earthwalker99 3y agoThey are just functionaries of the system who don't want to lose their job. Capital is in charge. This is capitalism after all.
- drc500free 3y agoMedical ethics really should preclude what these insurance company physicians are doing, which is sometimes rubber-stamping 5000 denials a day. Maybe an organized campaign of board complaints is in order. Propublica has done an excellent slate of investigatory articles recently about how insurance denials actually work.
- pylua 3y agoI don’t see how we can use ai and not have it generate new biases. I also feel like biases have been baked into insurance data in a discriminatory way for a long time — think about how much car insurance is for a 16 year old boy.
- sirspacey 3y agoYes but consider the alternative - how will we eliminate bias without it? Having worked in medical billing, it is very scary how medicine as an applied science is carrying around a huge ball and chain of “insurance hasn’t figured out that their medical model is decades out of date.” Big, complex, data intensify problems are not going to be solved by an army of humans on legacy ERPs.
- pylua 3y agoEveryone pays the same regardless of age, sex, etc? I understand they things are the way they are but part of change is making difficult decisions and tradeoffs.
- faeriechangling 3y agoI cannot even describe how many problems are caused by medicine being shackled to the whims of insurers in terms of how stultifying it is and how many bad incentives it creates to workaround the limitations of insurance. No idea how to fix the problem though.
- sirspacey 3y agoLike every single public good I’ve investigate for social entrepreneurship the answer is: Start an insurance company It sounds impossible, but every one of these giants were founded in the past century. They can be beaten with enough capital, power and ingenuity. But that’s not gonna be done by a pre-seed startup with $1M in the bank and some cool products. Genuine change requires a long view and a willingness to compete against a cartel.
- fbdab103 3y ago> In an example involving a decision to terminate post-acute care services, an algorithm or software tool can be used to assist providers or MA plans in predicting a potential length of stay, but that prediction alone cannot be used as the basis to terminate post-acute care services. So, the Random Forest can say, "No coverage", just so long as the human hits "Accept computer recommendations"
- vermarish 3y agoAs long as it spits out a p-value and the human decides it looks pretty small.
- mindslight 3y agoHow about just prohibiting them from denying coverage at all, except for bona fide fraud? So much of the rot of the healthcare system stems from this broken regulatory approach of thinking that corporate bureaucrats will somehow "manage" care better than patients and doctors can. These "insurance" companies should be relegated to a purely financial role, as a basic table stakes reform.
- oldpersonintx 3y ago[dead]
- bombcar 3y agoBecause everything is misaligned. There’s no reason to get a MRI for a basic headache, but if it’s free, why not? And attempts to solve this just muddle it worse, but some could help - nobody is going to voluntarily take insulin, for example, so just make those impossible to deny.
- BobaFloutist 3y ago> There’s no reason to get a MRI for a basic headache, but if it’s free, why not? Because an MRI is an exhausting, irritating experience.
- bberenberg 3y agoYes and if your doctor tells you that you need to do one will you argue? My understanding is that we’re already “over testing”, though would defer to someone with a citation on the topic.
- mindslight 3y agoYes, obviously you should "argue" and require an explanation of the doctor's reasoning. I just literally rejected doing an MRI this past weekend, in an emergency context, that would have been financially "free". The things it might have found were already disimplied by bloodwork, or were rare with no treatment options, and in my opinion the amount of iatrogenic harm from the procedure would have been unjustified. A patient or trusted advocated needs to be involved in a patient's own care, and the current "insurance" system does a great job at destroying this as doctors focus on "insurance" companies and associated bureaucracy as decision makers rather than patients. IMO this is precisely where the request to do an MRI was coming from in the first place - bureaucratic ass-covering.
- g42gregory 3y agoI think all it means that you need a person to push the final button. Am I wrong?
- bonton89 3y agoWhew, I was afraid this AI thing was going to mean we were all out of a job. But machines cannot replace the human ability to take the blame. You need a warm body for that.
- jmorenoamor 3y agoIf you run a health insurance company, you should not be able to deny coverage under any circumnstance. Yes, it sounds naive, but it is true.