5 ms·

There needs to be a consequence for improper denials, regardless of mechanism. Banning AI just means they have to hire people to rubber-stamp.

Mountain_Skies 2y ago
Debt collection companies have been sued and lost over similar type of behaviors where they had staff attorneys signing thousands of statements attesting they'd personally reviewed filings for errors, especially when it came to serving notice to defendants. Can't imagine the health insurance companies would do better than this unless they had scary pain beyond a potential token fine if caught.
- kevinventullo 2y ago
  The problem is that insurance companies can play chicken with regulators. If a debt collection company disappears overnight, basically some investors lose money and some debtors get a clean slate. If a health insurance company disappears… I imagine many people would not get healthcare who otherwise would.
  - Y_Y 2y ago
    It wouldn't be the first time a health insurance company shut down in response to regulation. For example they're was a case in Ireland regarding the local arm of Bupa[0]. To condense a complicated saga, a regulation obliged them to pay competitors to compensate for the fact that their clientele were a better risk than the average consumer. They considered all the obvious options: appeal, loophole, sell the business, temporary government takeover, merge into a competitor. In the end they did several of these and the Irish entity continues on as Laya, independent of the Bupa parent. At no point was it considered that people would lose cover, and in fact the regulator and government ensured that continuity of things like pre-existing conditions was covered so that the consumers weren't disadvantaged. Of course Ireland and the EU don't operate exactly like the US. I only mean to say it's possible to go through this process without harming the healthcare outcomes (except by the unavoidable loss of competition among providers).
    - disgruntledphd2 2y ago
      As an aside, it's pretty ludicrous that Community Rating is allowed to not be paid for the first three years of a company's operation, leads to shenanigans like this.
- Jimmc414 2y ago
  Unfortunately, after much debate and ABA lobbying the CFPB opted NOT to include safe harbor provisions for meaningful attorney involvement in the Final Debt Collection Practices Rule [0] [0] https://www.americanbar.org/advocacy/governmental_legislative_work/publications/washingtonletter/november-2020-wl/cfpb-1120wl/ https://www.americanbar.org/advocacy/governmental_legislativ...
martin-t 2y ago
This is what most people don't understand or don't want to understand. If the value proposition for antisocial behavior is positive when successful and zero when caught, then antisocial people will keep trying. Self-policing or teaching them to be "well-behaved" does not work. Many of them don't feel shame or remorse, some from birth, some because or psychological adaptations later in life. If their goal is to climb the ladder, get rich, get famous, they will not care how many people they hurt along the way unless the rest of society makes them lose something they value. The value proposition needs to be sufficiently negative to offset the potential payoff.
- luckman212 2y ago
  This is the reason some believe the "value proposition" of having the CEO executed point blank is justified.

Mountain_Skies 2y ago

Debt collection companies have been sued and lost over similar type of behaviors where they had staff attorneys signing thousands of statements attesting they'd personally reviewed filings for errors, especially when it came to serving notice to defendants. Can't imagine the health insurance companies would do better than this unless they had scary pain beyond a potential token fine if caught.

kevinventullo 2y ago
The problem is that insurance companies can play chicken with regulators. If a debt collection company disappears overnight, basically some investors lose money and some debtors get a clean slate. If a health insurance company disappears… I imagine many people would not get healthcare who otherwise would.
- Y_Y 2y ago
  It wouldn't be the first time a health insurance company shut down in response to regulation. For example they're was a case in Ireland regarding the local arm of Bupa[0]. To condense a complicated saga, a regulation obliged them to pay competitors to compensate for the fact that their clientele were a better risk than the average consumer. They considered all the obvious options: appeal, loophole, sell the business, temporary government takeover, merge into a competitor. In the end they did several of these and the Irish entity continues on as Laya, independent of the Bupa parent. At no point was it considered that people would lose cover, and in fact the regulator and government ensured that continuity of things like pre-existing conditions was covered so that the consumers weren't disadvantaged. Of course Ireland and the EU don't operate exactly like the US. I only mean to say it's possible to go through this process without harming the healthcare outcomes (except by the unavoidable loss of competition among providers).
  - disgruntledphd2 2y ago
    As an aside, it's pretty ludicrous that Community Rating is allowed to not be paid for the first three years of a company's operation, leads to shenanigans like this.
Jimmc414 2y ago
Unfortunately, after much debate and ABA lobbying the CFPB opted NOT to include safe harbor provisions for meaningful attorney involvement in the Final Debt Collection Practices Rule [0] [0] https://www.americanbar.org/advocacy/governmental_legislative_work/publications/washingtonletter/november-2020-wl/cfpb-1120wl/ https://www.americanbar.org/advocacy/governmental_legislativ...

martin-t 2y ago

This is what most people don't understand or don't want to understand. If the value proposition for antisocial behavior is positive when successful and zero when caught, then antisocial people will keep trying. Self-policing or teaching them to be "well-behaved" does not work. Many of them don't feel shame or remorse, some from birth, some because or psychological adaptations later in life. If their goal is to climb the ladder, get rich, get famous, they will not care how many people they hurt along the way unless the rest of society makes them lose something they value. The value proposition needs to be sufficiently negative to offset the potential payoff.

luckman212 2y ago
This is the reason some believe the "value proposition" of having the CEO executed point blank is justified.