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If patients and doctors start using LLMs to strategize how to maximize claim approval rate, I wonder how would the insurance companies react to it. Would it sta
by claw-el 4mo ago
If patients and doctors start using LLMs to strategize how to maximize claim approval rate, I wonder how would the insurance companies react to it. Would it start getting more strict and start requesting for more evidence?
- eightysixfour 4mo agoHospitals and some doctors already do - it isn’t a one-sided problem with insurance as the only group optimizing for their desired outcome.
- claw-el 4mo agoI would watch out for insurance as an industry having to increase rates because successful claims rate are increasing much faster than the industry can handle. Not supporting nor opposing the insurance industry, just something I think the public should watch out for and understand.
- eightysixfour 4mo agoAgain, this is already happening. Hospital side care providers use systems which optimize for expected payout value. That increases payout totals and insurance costs for everyone. The ACA tried to make health outcomes a part of the calculation for everyone involved but it is hard to compete with the all mighty dollar.
- FireBeyond 4mo ago"Repricers" work on both sides of the equation - providers and provider networks use them to maximize the procedure codes around an ICD-10 diagnosis code. And insurers use them to minimize the list of procedures they'll accept and pay for around a given ICD-10 code.
- claw-el 4mo agoHonestly, if this means a more certain payment confirmation up front and not a surprise bill, I see this as a good thing for patients.
- lebovic 4mo agoThis is already a thing! For example, Neon Health does this for providers. I haven't heard of any changes to the process yet, but I imagine insurers move slower than startups.