3 ms·
Does the UK's guy implement policies like mandatory first pass denial to encourage attrition, or try employing blackbox AI models to the task of denying care, a
by salawat 2y ago
Does the UK's guy implement policies like mandatory first pass denial to encourage attrition, or try employing blackbox AI models to the task of denying care, and attempting to mathwash?
I've worked in the space. Most people don't care about denials that are reasonable. I.e. escalation through "lets try these first drugs" when there isn't an established history of use. Ruling out less expensive problems before approving the most expensive operation. Thise aren't generally issues.
It's capricious denials happening over and over and over again, despite well established case history. Denials that clearly don't make sense. Prior Auths being used as financial "nudges".
That type of thing can screw right off. It's why I left the space after it proved absolutely impossible to get through to people that these measures were costing the lives of our customers. I bloody tried; and in the end, left for the sake of keeping what was left of my soul intact.
As far as I'm concerned the industry has made their bed. They can now sleep in it.