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Again, zeroing in on these denials is missing the forest for the trees. It's the entire claims process that is incentivized to dysfunctional. Insurers are payin
by Aunche 2y ago
Again, zeroing in on these denials is missing the forest for the trees. It's the entire claims process that is incentivized to dysfunctional. Insurers are paying for unnecessary chiropractic adjustments, name-brand prescriptions as a first resort, and the more expensive private rooms that hospitals like to build these days over shared ones. Occasionally, they'll fail to provide life saving care, but they can spin that into a win because that will give them an excuse to increase premiums even higher.
Psychiatric issues, which this Propublica article is about, are already being over-treated even though it may be under-treated in other aspects. Focusing only on these cases of denial may cause under-treatment to go down, but at a cost of much higher over-treatment, which comes out of everyones premiums. I don't think anything wrong with SSRIs or stimulants being used as medication, but clearly something wrong with the way we're prescribing them when despite being the largest consumers of them, Americans suffer more poor mental health outcomes.
- ssivark 2y agoWhen judging a system using the ROC curve, you need to evaluate both the precision AND the recall. You are pointing out that the precision is low, and must be improved; the article is pointing out that recall ought to be improved. Both are true, and we cannot use just one of the two metrics to evaluate system performance. https://en.wikipedia.org/wiki/Receiver_operating_characteristic https://en.wikipedia.org/wiki/Receiver_operating_characteris...