25 ms·

The problem with fighting claims is that it's an asymmetric game. You, the patient, must MAKE time outside of your regular life, to argue on the phone with some

The problem with fighting claims is that it's an asymmetric game. You, the patient, must MAKE time outside of your regular life, to argue on the phone with someone who is currently AT his full time job, and who feeds his family with YOUR premiums. It's a dirty game. Disputing charges, small claims court or simply never paying bills is the better option because the good faith channels are rigged.

toomuchtodo 2y ago
I help folks in r/sterilization who have obtained permanent birth control navigate and appeal their insurance. ACA compliant plans require this be covered at 100% as preventive care, so it’s building a workflow to check the boxes in the Rube Goldberg system to get to the outcome (full coverage per statue) insurance is constantly trying to avoid. This project is helpful and is going into the case management workflow right away. Fight slop with well crafted, guardrailed slop.
- elevatortester 2y ago
  @toomuchtodo - you probably won't see this, but I'm very interested in this cause. If you happen to want an extra brain to help out, email is in my profile
  - deleted 2y ago
    [deleted]
- pyuser583 2y ago
  Why the interest in sterilization? Because ACA makes it a very simple use case? Out of curiosity, does ACA require coverage if the doctor refuses?
  - toomuchtodo 2y ago
    Because it is the most aggressive way at almost no cost to empower someone’s reproductive rights in an adversarial socioeconomic system, while each avoided unwanted child is a net positive. Cost benefit ratio is enormous. ~40% of annual pregnancies (both US and international) are unintended, $330k cost 0-18 (2023 dollars), limited to no support for parents, etc. ACA coverage is for the procedure, doctors who won’t refuse can be found at https://childfreefriendlydoctors.com/ https://childfreefriendlydoctors.com/ If you want kids, Godspeed. If you don’t, I am building systems to radically empower that outcome. “Build something people want.” or something like that. Essentially a suffering reduction flywheel.
    - Suppafly 2y ago
      > ~40% of annual pregnancies (both US and international) are unintended how many are unwanted though? unintended doesn't necessarily have the negative connotation that /r/childfree folks make it out to be.
      - pinkmuffinere 2y ago
        To be fair, even if 5% are unwanted I would think this is a good investment of effort. I have no data though
        Suppafly 2y ago
        Sure, honestly I have no problem with people wanting to sterilize themselves, although I do somewhat support the idea that what you want at a younger age isn't necessarily what you want at a later point in your life, so sterilization should be handled at least somewhat seriously. That said, I do take umbrage with people using suspicious statistics in unusual ways to push an agenda. If your cause is just, there is no need to use misleading statistics to inflate its importance. I argue this for causes I support as well as those I don't support.
        pinkmuffinere 2y ago
        I don’t know why you’re getting downvoted, I feel you’ve expressed your views very well. I especially like > If your cause is just, there is no need to use misleading statistics to inflate its importance. I absolutely love this, and appreciate you calling it out. We need more of this.
      - toomuchtodo 2y ago
        https://www.pewresearch.org/social-trends/2024/07/25/the-experiences-of-u-s-adults-who-dont-have-children/ https://www.pewresearch.org/social-trends/2024/07/25/the-exp... https://www.axios.com/2024/07/25/adults-no-children-why-pew-data https://www.axios.com/2024/07/25/adults-no-children-why-pew-... > 64% of young women say they just don't want children, compared to 50% of men. Unfortunately, the dataset for unintended pregnancies doesn’t also ask if it was unwanted, leaving us to infer preferences via various datasets.
jb1991 2y ago
Not if you call them from work.
- antisthenes 2y ago
  Don't waste your employer's time. The morally correct choice is to just not pay.
  - snakeyjake 2y ago
    Since the vast majority of Americans are on health insurance plans provided to them by their employers as part of their compensation, fighting insurance claim denials is morally equivalent to fixing payroll or expense report errors.
  - lenerdenator 2y ago
    That then gets sent to collections and then you get to deal with that and the ramifications for your finances.
    - aketchum 2y ago
      cant show up on your credit report though - so why does this matter?
      - recursive 2y ago
        Why can't it?
      - lenerdenator 2y ago
        There's currently a proposal that medical debt not be taken into account on credit reports. [1] Personally, I just don't trust companies to not put that sort of thing in a credit report. Do we actually audit for that sort of thing? And what if they do? Assuming anyone finds out, they get to drag the punishment out over the span of years, and if they do get punished, it's probably only a fraction of the money that they earned by reducing risk. [1]https://www.consumerfinance.gov/about-us/newsroom/cfpb-proposes-to-ban-medical-bills-from-credit-reports/ https://www.consumerfinance.gov/about-us/newsroom/cfpb-propo...
vundercind 2y ago
Massive untracked cost of our healthcare system, too. We’re already more expensive per-capita than anywhere else, by a long shot, plus we impose huge costs on patients and their families in time & stress spent fighting the system. Any good-faith accounting of that would put our costs way in to “WTF is wrong with us that we’re not rushing to fix this immediately by any means necessary?!” territory. There are other hidden costs, too, like government employees who have to deal with private insurance issues for purposes of sorting out benefits and child support and all kinds of things, but aren’t primarily involved with healthcare so I’m sure those hours aren’t counted among costs of our healthcare system. Not sure about the hours (and hours, and hours) HR at entities public and private lose to dicking around with insurers and brokers and HSA providers and such. Doubt that’s counted, but it’s real and significant. Healthcare providers waste lots of money on similar things from their side, but I expect those figures make it in to even fairly naïve system cost estimates.
gamblor956 2y ago
Disputing charges, small claims court or simply never paying bills is the better option because the good faith channels are rigged. Yes to the first two, but the latter is a good way to get your credit score destroyed for a few years, and plenty of insurance companies are willing to send unpaid bills to collections agencies which are very aggressive about collecting.
- JohnMakin 2y ago
  > Yes to the first two, but the latter is a good way to get your credit score destroyed for a few years Not necessarily or at all - in California there are a bunch of laws about what healthcare debt can even be reported on your credit score. I routinely let things fall into collections and maintain a very high credit score because I ironically gain more negotiation power occasionally with the debt collector than whatever service I was charged for - often this happens as a result of over-billing. Dispute it enough times and they can just disappear. The credit hit is/should be minor. They use "credit" as an intimidation tool to coerce people into paying bills they don't actually owe. Classic example - I get a procedure. Doctor submits a claim that is pre-authorized (I don't know the exact term). You receive procedure, insurer later denies claim. The doctor then passes the bill to you. Later, the doctor and insurer may come to an agreement, and the doctor is paid - but sometimes/often this is never communicated back to the patient, effectively "double billing." In these cases the only sane way to navigate it is by simply allowing it to fall to collections.
ericmcer 2y ago
This is the dynamic that every corporation and government entity leverages. I feel like a frog noticing the water is starting to get hot as I see everything: water, power, trash, internet, groceries, registration fees, etc. getting more and more expensive and I just for sanity have to pay each one and forget it. Just this morning I was thinking how every single streaming service pushed out a version with ads and a more expensive ad-free version recently. It just comes to ~$20/mo to upgrade them all, but how much more can they pile on before people just have nothing left?
- mindslight 2y ago
  I haven't noticed Kodi or nfs-ganesha pushing out a version with ads? There are many markets that have been captured by duopolies and turned into inescapable extraction gauntlets, but when you've got some actual market power you've got to exercise it!
- metadaemon 2y ago
  I think about this a lot. It's certainly not sustainable for streaming companies to consistently increase end-user pricing. I understand why they are doing it, but there will only be an increasing number of individuals unwilling to watch X amount of ads or pay X amount a month.
- mmcconnell1618 2y ago
  Large companies consolidate industries and have the asymmetric advantage of more resources than individuals. They can leverage AI and other economic models to extract more and more from individuals. As we saw recently with Justice Department case against RealPage, the large companies can collude without officially colluding through better information access. The end result is that there is less slack in the economic system. There are fewer and fewer opportunities for individuals to leverage inefficiencies. It means there is less room to be human. Less room to make mistakes.
- danaris 2y ago
  This is enshittification[0], and while it's not a completely new phenomenon, it has expanded enormously since the end of zero interest rates. It is just the latest way of transferring wealth from the many to the few. [0] https://en.wikipedia.org/wiki/Enshittification https://en.wikipedia.org/wiki/Enshittification
jacobsenscott 2y ago
Yes, the asymmetry is how it is designed, but generative AI can turn the tables there. You should be able to sic an AI on the company and go back to watching your (AI generated) shows on netflix.
- DamnYuppie 2y ago
  How does this make sense? The insurance company has an overwhelming asymmetric advantage in regards to the data that is used to make such claim decisions and would be used to train such AI agents. Unless of course you are referring to legal proceedings specifically and not the data that would be used in the case.
  - jacobsenscott 2y ago
    You overestimate the ability of an insurance company to make use of AI - it will take them years of meetings, internal political maneuvering, technical failures, etc. Individuals can basically start using chatgpt today.
    - mrgoldenbrown 2y ago
      They already can reject your appeal based on BS like you didn't fax a form correctly (or more likely, you did but they claim they didn't get it), or they require a peer consult with your doctor and chose a time he wasn't available (on purpose). And don't forget they already use tech to speed up denials - Cigna had one doctor "review" and sign off on 60,000 a month via automation. That's under a minute a case, assuming he worked 24/7. It takes longer than that just to fax in your form. So you submit an appeal via AI, they spend 20 seconds rejecting it, with their tech stack from a few years ago. If they invest in AI it's only getting worse for individuals unless there are new regulations that put the burden of proof on the corps instead of on patients and doctors.
    - Suppafly 2y ago
      >You overestimate the ability of an insurance company to make use of AI They already do, and it's pretty obvious.
karmakaze 2y ago
The idea is to automate the tasks for the filing process. > She began helping friends file appeals, too, then asked herself a question that’s typical for engineers: Could she figure out a way to automate the process? > After a year of tinkering, she just launched her answer: Fight Health Insurance[0], an open-source platform that takes advantage of large language models to help users generate health insurance appeals with AI. [0] https://fighthealthinsurance.com/ https://fighthealthinsurance.com/
- ToucanLoucan 2y ago
  And then health insurance companies downsize their legal departments, replacing them with AI too. Next thing you know the entire system is just a bunch of large language models shooting email at one another and it becomes even more unwieldy and irritating to engage with.
  - datavirtue 2y ago
    That sounds more efficient.
  - blargey 2y ago
    The equilibrium would still converge on the letter of the policies and law, which is the goal of the endeavor. What will happen to insurance companies (and policies) once they can no longer rely on flippant violations to pad their profits depends on other factors.
    - ToucanLoucan 2y ago
      I think it's a very generous assumption on your part that increased infiltration of AI into this process will benefit consumers more than the corporations. It would make AI fundamentally different from... I mean, every previous technological innovation in the history of corporate structures, and previous to them, the robber-baron empires? And I mean, it could be, the history has yet to be written for AI in terms of it's long-term effects on industries, but I think as I said it's very generous on your part to preemptively assume that it will benefit the customers.
doctorpangloss 2y ago
If some people stop paying bills, will healthcare prices go up, or down? Prices is a purposeful word choice. I don’t mean costs, or your costs. I mean agnostic to who is paying - whether it’s a compulsory non tax payment via insurance and hence the price the insurer sees, or the price you pay for insurance, or the price that CMS pays for an appointment, whatever.

toomuchtodo 2y ago

I help folks in r/sterilization who have obtained permanent birth control navigate and appeal their insurance. ACA compliant plans require this be covered at 100% as preventive care, so it’s building a workflow to check the boxes in the Rube Goldberg system to get to the outcome (full coverage per statue) insurance is constantly trying to avoid. This project is helpful and is going into the case management workflow right away. Fight slop with well crafted, guardrailed slop.

elevatortester 2y ago
@toomuchtodo - you probably won't see this, but I'm very interested in this cause. If you happen to want an extra brain to help out, email is in my profile
- deleted 2y ago
  [deleted]
pyuser583 2y ago
Why the interest in sterilization? Because ACA makes it a very simple use case? Out of curiosity, does ACA require coverage if the doctor refuses?
- toomuchtodo 2y ago
  Because it is the most aggressive way at almost no cost to empower someone’s reproductive rights in an adversarial socioeconomic system, while each avoided unwanted child is a net positive. Cost benefit ratio is enormous. ~40% of annual pregnancies (both US and international) are unintended, $330k cost 0-18 (2023 dollars), limited to no support for parents, etc. ACA coverage is for the procedure, doctors who won’t refuse can be found at https://childfreefriendlydoctors.com/ https://childfreefriendlydoctors.com/ If you want kids, Godspeed. If you don’t, I am building systems to radically empower that outcome. “Build something people want.” or something like that. Essentially a suffering reduction flywheel.
  - Suppafly 2y ago
    > ~40% of annual pregnancies (both US and international) are unintended how many are unwanted though? unintended doesn't necessarily have the negative connotation that /r/childfree folks make it out to be.
    - pinkmuffinere 2y ago
      To be fair, even if 5% are unwanted I would think this is a good investment of effort. I have no data though
      - Suppafly 2y ago
        Sure, honestly I have no problem with people wanting to sterilize themselves, although I do somewhat support the idea that what you want at a younger age isn't necessarily what you want at a later point in your life, so sterilization should be handled at least somewhat seriously. That said, I do take umbrage with people using suspicious statistics in unusual ways to push an agenda. If your cause is just, there is no need to use misleading statistics to inflate its importance. I argue this for causes I support as well as those I don't support.
        pinkmuffinere 2y ago
        I don’t know why you’re getting downvoted, I feel you’ve expressed your views very well. I especially like > If your cause is just, there is no need to use misleading statistics to inflate its importance. I absolutely love this, and appreciate you calling it out. We need more of this.
    - toomuchtodo 2y ago
      https://www.pewresearch.org/social-trends/2024/07/25/the-experiences-of-u-s-adults-who-dont-have-children/ https://www.pewresearch.org/social-trends/2024/07/25/the-exp... https://www.axios.com/2024/07/25/adults-no-children-why-pew-data https://www.axios.com/2024/07/25/adults-no-children-why-pew-... > 64% of young women say they just don't want children, compared to 50% of men. Unfortunately, the dataset for unintended pregnancies doesn’t also ask if it was unwanted, leaving us to infer preferences via various datasets.

jb1991 2y ago

Not if you call them from work.

antisthenes 2y ago
Don't waste your employer's time. The morally correct choice is to just not pay.
- snakeyjake 2y ago
  Since the vast majority of Americans are on health insurance plans provided to them by their employers as part of their compensation, fighting insurance claim denials is morally equivalent to fixing payroll or expense report errors.
- lenerdenator 2y ago
  That then gets sent to collections and then you get to deal with that and the ramifications for your finances.
  - aketchum 2y ago
    cant show up on your credit report though - so why does this matter?
    - recursive 2y ago
      Why can't it?
    - lenerdenator 2y ago
      There's currently a proposal that medical debt not be taken into account on credit reports. [1] Personally, I just don't trust companies to not put that sort of thing in a credit report. Do we actually audit for that sort of thing? And what if they do? Assuming anyone finds out, they get to drag the punishment out over the span of years, and if they do get punished, it's probably only a fraction of the money that they earned by reducing risk. [1]https://www.consumerfinance.gov/about-us/newsroom/cfpb-proposes-to-ban-medical-bills-from-credit-reports/ https://www.consumerfinance.gov/about-us/newsroom/cfpb-propo...

vundercind 2y ago

Massive untracked cost of our healthcare system, too. We’re already more expensive per-capita than anywhere else, by a long shot, plus we impose huge costs on patients and their families in time & stress spent fighting the system. Any good-faith accounting of that would put our costs way in to “WTF is wrong with us that we’re not rushing to fix this immediately by any means necessary?!” territory. There are other hidden costs, too, like government employees who have to deal with private insurance issues for purposes of sorting out benefits and child support and all kinds of things, but aren’t primarily involved with healthcare so I’m sure those hours aren’t counted among costs of our healthcare system. Not sure about the hours (and hours, and hours) HR at entities public and private lose to dicking around with insurers and brokers and HSA providers and such. Doubt that’s counted, but it’s real and significant. Healthcare providers waste lots of money on similar things from their side, but I expect those figures make it in to even fairly naïve system cost estimates.

gamblor956 2y ago

Disputing charges, small claims court or simply never paying bills is the better option because the good faith channels are rigged. Yes to the first two, but the latter is a good way to get your credit score destroyed for a few years, and plenty of insurance companies are willing to send unpaid bills to collections agencies which are very aggressive about collecting.

JohnMakin 2y ago
> Yes to the first two, but the latter is a good way to get your credit score destroyed for a few years Not necessarily or at all - in California there are a bunch of laws about what healthcare debt can even be reported on your credit score. I routinely let things fall into collections and maintain a very high credit score because I ironically gain more negotiation power occasionally with the debt collector than whatever service I was charged for - often this happens as a result of over-billing. Dispute it enough times and they can just disappear. The credit hit is/should be minor. They use "credit" as an intimidation tool to coerce people into paying bills they don't actually owe. Classic example - I get a procedure. Doctor submits a claim that is pre-authorized (I don't know the exact term). You receive procedure, insurer later denies claim. The doctor then passes the bill to you. Later, the doctor and insurer may come to an agreement, and the doctor is paid - but sometimes/often this is never communicated back to the patient, effectively "double billing." In these cases the only sane way to navigate it is by simply allowing it to fall to collections.

ericmcer 2y ago

This is the dynamic that every corporation and government entity leverages. I feel like a frog noticing the water is starting to get hot as I see everything: water, power, trash, internet, groceries, registration fees, etc. getting more and more expensive and I just for sanity have to pay each one and forget it. Just this morning I was thinking how every single streaming service pushed out a version with ads and a more expensive ad-free version recently. It just comes to ~$20/mo to upgrade them all, but how much more can they pile on before people just have nothing left?

mindslight 2y ago
I haven't noticed Kodi or nfs-ganesha pushing out a version with ads? There are many markets that have been captured by duopolies and turned into inescapable extraction gauntlets, but when you've got some actual market power you've got to exercise it!
metadaemon 2y ago
I think about this a lot. It's certainly not sustainable for streaming companies to consistently increase end-user pricing. I understand why they are doing it, but there will only be an increasing number of individuals unwilling to watch X amount of ads or pay X amount a month.
mmcconnell1618 2y ago
Large companies consolidate industries and have the asymmetric advantage of more resources than individuals. They can leverage AI and other economic models to extract more and more from individuals. As we saw recently with Justice Department case against RealPage, the large companies can collude without officially colluding through better information access. The end result is that there is less slack in the economic system. There are fewer and fewer opportunities for individuals to leverage inefficiencies. It means there is less room to be human. Less room to make mistakes.
danaris 2y ago
This is enshittification[0], and while it's not a completely new phenomenon, it has expanded enormously since the end of zero interest rates. It is just the latest way of transferring wealth from the many to the few. [0] https://en.wikipedia.org/wiki/Enshittification https://en.wikipedia.org/wiki/Enshittification

jacobsenscott 2y ago

Yes, the asymmetry is how it is designed, but generative AI can turn the tables there. You should be able to sic an AI on the company and go back to watching your (AI generated) shows on netflix.

DamnYuppie 2y ago
How does this make sense? The insurance company has an overwhelming asymmetric advantage in regards to the data that is used to make such claim decisions and would be used to train such AI agents. Unless of course you are referring to legal proceedings specifically and not the data that would be used in the case.
- jacobsenscott 2y ago
  You overestimate the ability of an insurance company to make use of AI - it will take them years of meetings, internal political maneuvering, technical failures, etc. Individuals can basically start using chatgpt today.
  - mrgoldenbrown 2y ago
    They already can reject your appeal based on BS like you didn't fax a form correctly (or more likely, you did but they claim they didn't get it), or they require a peer consult with your doctor and chose a time he wasn't available (on purpose). And don't forget they already use tech to speed up denials - Cigna had one doctor "review" and sign off on 60,000 a month via automation. That's under a minute a case, assuming he worked 24/7. It takes longer than that just to fax in your form. So you submit an appeal via AI, they spend 20 seconds rejecting it, with their tech stack from a few years ago. If they invest in AI it's only getting worse for individuals unless there are new regulations that put the burden of proof on the corps instead of on patients and doctors.
  - Suppafly 2y ago
    >You overestimate the ability of an insurance company to make use of AI They already do, and it's pretty obvious.

karmakaze 2y ago

The idea is to automate the tasks for the filing process. > She began helping friends file appeals, too, then asked herself a question that’s typical for engineers: Could she figure out a way to automate the process? > After a year of tinkering, she just launched her answer: Fight Health Insurance[0], an open-source platform that takes advantage of large language models to help users generate health insurance appeals with AI. [0] https://fighthealthinsurance.com/ https://fighthealthinsurance.com/

ToucanLoucan 2y ago
And then health insurance companies downsize their legal departments, replacing them with AI too. Next thing you know the entire system is just a bunch of large language models shooting email at one another and it becomes even more unwieldy and irritating to engage with.
- datavirtue 2y ago
  That sounds more efficient.
- blargey 2y ago
  The equilibrium would still converge on the letter of the policies and law, which is the goal of the endeavor. What will happen to insurance companies (and policies) once they can no longer rely on flippant violations to pad their profits depends on other factors.
  - ToucanLoucan 2y ago
    I think it's a very generous assumption on your part that increased infiltration of AI into this process will benefit consumers more than the corporations. It would make AI fundamentally different from... I mean, every previous technological innovation in the history of corporate structures, and previous to them, the robber-baron empires? And I mean, it could be, the history has yet to be written for AI in terms of it's long-term effects on industries, but I think as I said it's very generous on your part to preemptively assume that it will benefit the customers.

doctorpangloss 2y ago

If some people stop paying bills, will healthcare prices go up, or down? Prices is a purposeful word choice. I don’t mean costs, or your costs. I mean agnostic to who is paying - whether it’s a compulsory non tax payment via insurance and hence the price the insurer sees, or the price you pay for insurance, or the price that CMS pays for an appointment, whatever.