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error-prone automation, programmed from the ground up to prioritize money over health, is incorrectly denying essential insurance coverage to the elderly. I re

error-prone automation, programmed from the ground up to prioritize money over health, is incorrectly denying essential insurance coverage to the elderly. I remember being interviewed once for an opportunity in a startup working in developing a product that using AI they would automate answering to incorrect insurance denials (which is a tedious process). AI or not, the problem of incorrect denials is so bad that there is a market for it.

zardo 2y ago
> AI or not, the problem of incorrect denials is so bad that there is a market for it. Who is the customer? Insurance companies?
- sebastianconcpt 2y ago
  Smaller clinics that would feel heavy to have one hire full time doing just that.
nolongerthere 2y ago
Yea there are cottage industries on top of cottage industries in the medical insurance space. First you have the first order: DR supplies service, bills patient’s insurance, then you have the hospitals who outsource all billing, those outsourced companies outsource the claims management, which outsource the claims response, and the exact same structure exists on the insurance company side. And I’ve simplified a lot… there are coder companies, insurance coder consultants, etc. it’s totally wild. If you ever wonder why. US medicine is so expensive: it’s bec there are 100 hands all reaching for their piece of your $120 annual checkup. Or put another way, HIPPA is nice and all, but by the time all is said and done, 8-10 pairs of strangers eyes have seen your vagina fungus infection pharmacy bill.
- TheNewsIsHere 2y ago
  I once was lucky enough to have my primary care physician through a university teaching hospital that outsourced almost nothing. Billing was in-house, insurance ops and claims processing was in-house. Labs went to an accredited in-house reference laboratory. I am sure it was easy to justify doing everything in-house because the university held accredited degree programs for virtually every healthcare area from medical school to ophthalmology and optometry, physical therapy, pathology, dentistry, a college of nursing, pharmacy school, as well as specialties like oncology, cardiology, and anesthesiology. For the areas that weren't medical disciplines, they operated degree programs for bioinformatics, hospitality (the hospital cafeteria was excellent), and several other areas that just so happened to address essentially all the needs of a modern healthcare organization. It was a fantastic model, but it might have only made sense in the context of a large teaching hospital.

zardo 2y ago

> AI or not, the problem of incorrect denials is so bad that there is a market for it. Who is the customer? Insurance companies?

sebastianconcpt 2y ago
Smaller clinics that would feel heavy to have one hire full time doing just that.

nolongerthere 2y ago

Yea there are cottage industries on top of cottage industries in the medical insurance space. First you have the first order: DR supplies service, bills patient’s insurance, then you have the hospitals who outsource all billing, those outsourced companies outsource the claims management, which outsource the claims response, and the exact same structure exists on the insurance company side. And I’ve simplified a lot… there are coder companies, insurance coder consultants, etc. it’s totally wild. If you ever wonder why. US medicine is so expensive: it’s bec there are 100 hands all reaching for their piece of your $120 annual checkup. Or put another way, HIPPA is nice and all, but by the time all is said and done, 8-10 pairs of strangers eyes have seen your vagina fungus infection pharmacy bill.

TheNewsIsHere 2y ago
I once was lucky enough to have my primary care physician through a university teaching hospital that outsourced almost nothing. Billing was in-house, insurance ops and claims processing was in-house. Labs went to an accredited in-house reference laboratory. I am sure it was easy to justify doing everything in-house because the university held accredited degree programs for virtually every healthcare area from medical school to ophthalmology and optometry, physical therapy, pathology, dentistry, a college of nursing, pharmacy school, as well as specialties like oncology, cardiology, and anesthesiology. For the areas that weren't medical disciplines, they operated degree programs for bioinformatics, hospitality (the hospital cafeteria was excellent), and several other areas that just so happened to address essentially all the needs of a modern healthcare organization. It was a fantastic model, but it might have only made sense in the context of a large teaching hospital.