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AI adjudication of healthcare is fine but there needs to be extremely steep consequences for false negatives and a truly independent board of medical experts to

AI adjudication of healthcare is fine but there needs to be extremely steep consequences for false negatives and a truly independent board of medical experts to appeal to. If a large panel agrees the denial was wrong, a penalty of 10-100x the cost of procedure would be assessed depending on the consequence of the denial.

throw10920 1y ago
Yes, I agree. My point was contingent on the current state of affairs - until we can change that, then AI remains a terrible idea.
reassess_blind 1y ago
No one is going to accept a claim rejection from AI. Everyone will want to dispute, which will have to go to a human to review. At the end of the day I don’t see how 100 people is realistic.
- mring33621 1y ago
  Fine! You win! We'll send the appeals through Mechanical Turk. Happy now?
- bcyn 1y ago
  This reaction is primarily an emotional one. Why is a human rejecting a claim better than an AI rejecting a claim? Presumably the AI will one day -- if not today -- be more accurate in following decisioning logic than humans, who will continue to make human errors.
  - potato3732842 1y ago
    The AI won't reject a claim because that's easier than doing the paperwork to approve the claim and it's 4:30 on a Friday. It also won't approve it because despite not putting the "magic words" on the form it's clear from the situation that you'll get approved regardless and it's a waste of the company's labor to have you file an appeal that they then have to review. I'm not sure which case is more common though.
- aianus 1y ago
  If that were true then they would also dispute every first-line human review. I don't think the average first-line human customer service rep is any better than AI even today.
vkou 1y ago
Or, and here's the wild thing, put all these parasites, leeches, and other useless middle-men out of a job and just go single-payer.

throw10920 1y ago

Yes, I agree. My point was contingent on the current state of affairs - until we can change that, then AI remains a terrible idea.

reassess_blind 1y ago

No one is going to accept a claim rejection from AI. Everyone will want to dispute, which will have to go to a human to review. At the end of the day I don’t see how 100 people is realistic.

mring33621 1y ago
Fine! You win! We'll send the appeals through Mechanical Turk. Happy now?
bcyn 1y ago
This reaction is primarily an emotional one. Why is a human rejecting a claim better than an AI rejecting a claim? Presumably the AI will one day -- if not today -- be more accurate in following decisioning logic than humans, who will continue to make human errors.
- potato3732842 1y ago
  The AI won't reject a claim because that's easier than doing the paperwork to approve the claim and it's 4:30 on a Friday. It also won't approve it because despite not putting the "magic words" on the form it's clear from the situation that you'll get approved regardless and it's a waste of the company's labor to have you file an appeal that they then have to review. I'm not sure which case is more common though.
aianus 1y ago
If that were true then they would also dispute every first-line human review. I don't think the average first-line human customer service rep is any better than AI even today.

vkou 1y ago

Or, and here's the wild thing, put all these parasites, leeches, and other useless middle-men out of a job and just go single-payer.