You Didn’t See This Coming
“A recent investigation by STAT News found that AI algorithms have influenced how Medicare insurers deny insurance to patients. In some cases, insurers cut off benefits for elderly patients because the AI says they should be better, ignoring what human doctors have to say about the patient’s condition.”
To which I add, Hahahahahahahahahahahahahahahahahahahahahahahaha… Not a joyful haha, etc mind you, but a bitter, sardonic laugh at people gathering the fruits of their planting.
Insurance exists to make a profit by taking in premiums, and then denying payment, as any Florida coastal resident can tell you. Health insurance is no different. Convincing retirees that they deserve medical care as a compulsory “right” backed with government force manipulated by tech lobbyists leads to this (and before you start with the “but they paid for it” moaning, realize that this awful program has caused medical price inflation since its inception, and that the average “beneficiary” consumes more than they contribute, so no, they did not “pay for it”).
“Behind the scenes, insurers are using unregulated predictive algorithms, under the guise of scientific rigor, to pinpoint the precise moment when they can plausibly cut off payment for an older patient’s treatment. The denials that follow are setting off heated disputes between doctors and insurers, often delaying treatment of seriously ill patients who are neither aware of the algorithms, nor able to question their calculations.” As the source explains, the AI is often ignoring any input from fallible organic life forms claiming to be physicians.
“While the firms say [the algorithm] is suggestive, it ends up being a hard-and-fast rule that the plan or the care management firms really try to follow … There’s no deviation from it, no accounting for changes in condition, no accounting for situations in which a person could use more care.” While this is only Medicare Advantage for the moment, all of Medicare is sure to follow. And as Big Insurance always follows Medicare the way bank lending rates follow the Prime, so too will private insurance plans rush to get on this new claims-denial money train, we can bet on it.
After an 85-year old post-fall/fracture patient was essentially snuffed out by the compassionate calculations, her Medicare Advantage managing plan, NaviHealth explained it all: “The NaviHealth predict tool is not used to make coverage determinations,” the statement said. “The tool is used as a guide to help us inform providers, families and other caregivers about what sort of assistance and care the patient may need both in the facility and after returning home.” Except the “predict tool” was used in conjunction with its organic collaborator, a Quisling guard dog medical director who “cited the algorithm’s estimated length of stay prediction — 16.6 days — in asserting that Walter no longer met Medicare’s coverage criteria because she had sufficiently recovered…” The arrangement not only denied further payment to the uncooperative patient, it efficiently bankrupted her by forcing her into Medicaid in the closing weeks of her life.
“We take patients who are going to die of their diseases within a three-month period of time, and we force them into a denial and appeals process that lasts up to 2.5 years … So what happens is the appeal outlasts the beneficiary.” Now THAT is efficiency.
“UnitedHealthcare and other insurers said they offer to discuss a patient’s care with providers before a denial is made. But many providers said their attempts to get explanations are met with blank stares and refusals to share more information. The black box of the AI has become a blanket excuse for denials.” Which sounds like the old “because HIPAA” shell game.
Remember these bastards, and how they said these fears were all overblown? It looks like they are still achieving their dreams when a rose by any other name is still on a grave, and doctors are still too benighted and cowardly to lead society away from this trap.
Everything Is A Business Model! GOVERNMENT, MARRIAGE, RELIGION, WAR. INSURANCE.
Some states have approved Euthanasia. Yes in Denmark, Cancda, some US STATES, yes they offer you suicide. Yes it saves Money.. How nice to be part of a caring profession, First Do No Harm.. as long as it does not affect the bottom line.. ENJOY !!!
Killing someone, even with a knife, seems to take some money. Certainly bullets are expensive and all that hunger games craziness of Logan‘s run was very expensive. Denying care is cheap. If I was Skynet, this is exactly how I would start. Efficient. Economical.
“While this is only Medicare Advantage for the moment, all of Medicare is sure to follow. And as Big Insurance always follows Medicare the way bank lending rates follow the Prime . . . ”
Not quite accurate.
Medicare Advantage, along with Medicare Supplemental, Medicare Part D, and Obamacare ARE (despite the names) Big Insurance.
All the abuses described – prior auths, formularies, PBMs, narrow networks, etc. – were created by Big Insurance. Traditional government-run Medicare has picked up on almost none of them.
Not promoting Medicare for all, but we need to accurate on passing out the blame.
Exactly. Everybody was freaking out about ‘death panels’ (remember?) when Medicare starting paying for end of life discussions. Turns out it wasn’t Medicare or the government we had to worry about, it was insurance companies who stood to make more money if folks die quicker and cost less. One of the MA plans in our area is opening a whole chain of “elder care” clinics. The pictures in their ads are reminiscent of the place poor old Edward G Robinison went to be euthanized in ‘Soylent Green’. Don’t think I’d eat the crackers there though.
I disagree – this is the same kind of thinking that people used to defend government involvement during the 2008 real estate collapse, claiming it was Fannie Mae/Freddie Mac were only government “sponsored” entities.
MA would not have been created had not Medicare already existed and was looking for a way to cut costs. What we have is grossly expensive crony corporatism, each part of which corrupts the other, but in the end always devolves to more state control.
It is ALWAYS the government we need to worry about when it comes to health care, and as our currency continues to fail, the rationing will accelerate.
So what’s next? Will AI convene a panel to suggest SUICIDE before handing down a denial?