The fact that there's shares to be had for denying care is crazy. They know denying care is their business! Meaning that the money they didn't spend on your care doesn't go back into the pot for everyone in your group, they are pocketing some of the money whenever they deny someone. That's it. They don't help anyone but themselves. There should be a requirement that insurance companies publicly announce how much money they made from denying care
Ah, see, there's your problem: you're using a slight mistranslation. A common mistake. They were never the party of "Family Values". They're the party of "Family Valuations". They exist to find a way to put a number on every family, either "amount of money we can squeeze out of them" or "amount of money we can make by destroying them", and they get bonuses from their corpocratic upstream if they can manage both at the same time.
Every accusation is a confession, right? That's how conservatives work. They're unimaginative people with poor empathy. They think about what they would do and assume that's what everyone else would do, too. They are trash. Failures. Disappointments.
Failures in every way except for gaining power and wealth. A few of them anyway. The sad reality is that throughout history being ruthless always paid off to a large extent.
Some of the leadership is getting a lot of wealth, true. The majority seem to be losing more. Loss of government programs (eg: Medicare). Return of preventable diseases (eg: measles). Pollution and climate change.
Evangelical Christianity. They have always claimed that “absolute evil” exists. They have won the philosophical debate, by demonstrating the Platonic form of evil.
The goal of the healthcare system should be to treat people.
The goal of a good healthcare system is to treat people. The goal of ours is to treat the rich to another yacht. Healthcare providers bill far above cost for profit, knowing that either the insurance or the patient will have no choice but to eat the cost. Insurance providers use high healthcare costs to justify high policy prices and then do unethical shit to avoid paying out.
The hospitals make money. The insurance company makes money. The shareholders and corporate owners make money. The people needing healthcare get screwed.
The system is, unfortunately, working as intended for those who benefit from it being the way it is.
Cystic acne treatment is frequently covered by insurance and the same treatment is desirable to those that suffer from normal acne. Emotional support animals required doctors notes and were desirable for free admittance on planes. Ozempic as a weight loss drug. Topical steroid treatments for treating inflammation. Glasses to see better than 20/20.
There are all kinds of medical treatments (relatively) healthy people would want if they were affordable and knew they existed.
Perhaps so, but it should be up to a medical professional (doctor) whether or not those treatments are appropriate for the patient. Not for-profit companies run by sociopathic executives. (Although in this case we are talking about state-run Medicare using private companies’ AI to make the determination.)
They're trying... But it's almost performative. I calmed down a lot when they complied with the orders to shut down alligator Auschwitz, now we've got ICE whining about how no one likes them, people aren't coming to their hearings to get picked up, and all that bullshit about denaturalization seems to have been dropped
Don't get me wrong, it's still horrible, we need to fight it, and we need to disband ICE and have trials when this is all over... But it's not the defining aspect of this administration
Those tents and cages in the Everglades cost hundreds of millions to set up, and probably a comparable amount to tear down. Money that was set aside for disaster recovery. The majority of that money went in someone's pocket
And that's the real defining aspect of the administration. They're fascist enough to do fascism, but they're too busy looting the government for profit to commit to it
Big profile you should be able to track him down easy in the wee hours of the morning to ask some questions as any good citizen of someone representing their interests.
Officials assert that the AI tools will only be used to judge claims for about a dozen different types of procedures it deems to be wasteful and providing little benefit, including steroid shots to relieve pain, per the NYT.
Yeah cause people on medicare aren't likely to need steroid shots for things like joint pain or anything. Anyone 65 and older should start saving their money now to pay for their steroid shots that are going to start costing them a couple hundred bucks a pop.
As someone who lives with constant pain, calling pain relief of any kind "wasteful" enrages me. See if pain relief has "little benefit" when im done with you, mufucka
If payments out of pocket were reasonable maybe we are charged like a hundred times what everybody elsein the world pays.
Investors like private equity have taken over Health Care and are extracting the life savings of baby boomers for medical care that used to cost a reasonable amount of money.
This is the point. They want to erase any legacy either of them left. Trump is a petty little asshole who is still mad that Obama made fun of him once.
And who knows how long that'll take. While we're waiting to see if your pain is considered valid enough to warrant relief, here's a wooden spoon to bite down on.
So bribe the private sector to deny all claims routed through them first for government healthcare and then claim 'gUbmEnT dEAtH pANEls!' are the problem.
I've wondered this for a while: Insurance is a contractual obligation on the insurer's part, right? What's stopping me from just suing them for breach of contract rather than going through their appeals process if they illegally deny my claim?
What’s stopping me from just suing them for breach of contract rather than going through their appeals process if they illegally deny my claim?
Medicaid is a government provision that has no contract that underpins it. With something like United Healthcare, there is a bargained for exchange of mutual consideration (you give $ and UHC provides insurance subject to all the terms and conditions in the contract).
That is not something in Medicaid because Medicaid isn't getting anything in exchange for its health coverage. The government can put whatever restrictions on it that it wants. The benefit comes from the government having one more contribution to the ecconomic system. However, that is too attenuated of a benefit to say that there was a bargained-for exchange.
Ah! Americans need to be willing to dig deep—really tough it out—to cut costs and save as much money as AI makes possible so that the government can give just 1 more penny to the billionaires. Won't someone please think of the billionaires?
what the fuck kind of country looks to save billions of dollars spent on healthcare for their own citizens instead of waste fraud & abuse by the uber wealthy, or the military?
you can have an insanely strong military without the waste & fraud that exists in the US
I didn't know I still had any faith to lose in the insurance industry. At this point anyone in a management position is undeniably evil, in all senses of the word. I wish nothing but the worst for them.
The point is fraud. They give you just enough to think they will cover you when you really need it. And by then, they've already extracted the optimum amount they were gonna get from you.
This is definitely the wrong "motive structure" for administrative decisions from agency supposed to provide healthcare. Proof of grift as a goal.
By all means, use AI assistance to determine claims validity. But the AI service should be paid per query, or to licence whole model for unlimited use with medicare paying for the computers/gpus. Medicare should be choosing a model that is accurate instead of one that is paid to deny everything, because Homer Simpson's birdy automation can do that ultra cheap.
Taking claim validity away from the doctor that's actually in charge of the patient's care is already fucked. AI cost cutting doesn't belong in medicine full stop. It shouldn't be a for-profit "industry" in the first place. We're so fucked nobody can even think about this without insane, anti-human framing coloring everything
Private medical insurance is corrupt as starting point. A public health insurance/payer system can still be subject to ineligible or fraudulent claims. Every medical provider demand for money automatically accepted is not the perfect model either. Systems, AI or not, should avoid improper denials is a standard only possible in public health systems.
113 Comments
can@sh.itjust.works · 195 pts · 336d
Well that's the worst headline I have read in a while
NatakuNox@lemmy.world · 57 pts · 336d
The fact that there's shares to be had for denying care is crazy. They know denying care is their business! Meaning that the money they didn't spend on your care doesn't go back into the pot for everyone in your group, they are pocketing some of the money whenever they deny someone. That's it. They don't help anyone but themselves. There should be a requirement that insurance companies publicly announce how much money they made from denying care
doctortofu@piefed.social · 166 pts · 336d
Literally and with no exaggeration, death panels. You know, the ones Republicans were yelling about a few years ago. Those exact fucking ones.
Maeve@kbin.earth · 56 pts · 336d
Those same ones who screamed about fema prisons... At some point, we'll catch on that these conspiracy theories are actual plans...
dohpaz42@lemmy.world · 24 pts · 336d
The question is: which came first? The conspiracy theory, or the plan? It could go either way with the party of family values.
wolframhydroxide@sh.itjust.works · 12 pts · 336d
Ah, see, there's your problem: you're using a slight mistranslation. A common mistake. They were never the party of "Family Values". They're the party of "Family Valuations". They exist to find a way to put a number on every family, either "amount of money we can squeeze out of them" or "amount of money we can make by destroying them", and they get bonuses from their corpocratic upstream if they can manage both at the same time.
jjjalljs@ttrpg.network · 19 pts · 336d
Every accusation is a confession, right? That's how conservatives work. They're unimaginative people with poor empathy. They think about what they would do and assume that's what everyone else would do, too. They are trash. Failures. Disappointments.
ArmchairAce1944@discuss.online · 2 pts · 335d
Failures in every way except for gaining power and wealth. A few of them anyway. The sad reality is that throughout history being ruthless always paid off to a large extent.
jjjalljs@ttrpg.network · 2 pts · 335d
Some of the leadership is getting a lot of wealth, true. The majority seem to be losing more. Loss of government programs (eg: Medicare). Return of preventable diseases (eg: measles). Pollution and climate change.
ArmchairAce1944@discuss.online · 2 pts · 335d
I was referring to those at the top. Most of them will be giant failures in life. But the ones that 'succeed' sadly will have more money than God.
gravitas_deficiency@sh.itjust.works · 16 pts · 336d
More than that: fully automated death panels.
ameancow@lemmy.world · 15 pts · 336d
lucretius@slrpnk.net · 3 pts · 335d
Evangelical Christianity. They have always claimed that “absolute evil” exists. They have won the philosophical debate, by demonstrating the Platonic form of evil.
favoredponcho@lemmy.zip · 95 pts · 336d
pivot_root@lemmy.world · 36 pts · 336d
The goal of a good healthcare system is to treat people. The goal of ours is to treat the rich to another yacht. Healthcare providers bill far above cost for profit, knowing that either the insurance or the patient will have no choice but to eat the cost. Insurance providers use high healthcare costs to justify high policy prices and then do unethical shit to avoid paying out.
The hospitals make money. The insurance company makes money. The shareholders and corporate owners make money. The people needing healthcare get screwed.
The system is, unfortunately, working as intended for those who benefit from it being the way it is.
andros_rex@lemmy.world · 17 pts · 336d
The problem is a lack of residencies, and there’s been lobbying to keep the number of residencies low, to keep doctor wages high.
favoredponcho@lemmy.zip · 9 pts · 336d
Pieisawesome@lemmy.dbzer0.com · 2 pts · 334d
Rejecting claims does have some legitimate purposes.
Invalid ID numbers, people aren’t actually a customer of the insurance company, unreadable data, and actual medical fraud to name a few.
Denials should trigger a government review that the insurance company must justify to a neutral 3rd party that has a medical degree
jumping_redditor@sh.itjust.works · -7 pts · 335d
Cystic acne treatment is frequently covered by insurance and the same treatment is desirable to those that suffer from normal acne. Emotional support animals required doctors notes and were desirable for free admittance on planes. Ozempic as a weight loss drug. Topical steroid treatments for treating inflammation. Glasses to see better than 20/20.
There are all kinds of medical treatments (relatively) healthy people would want if they were affordable and knew they existed.
localhost001@lemmy.world · 3 pts · 335d
Perhaps so, but it should be up to a medical professional (doctor) whether or not those treatments are appropriate for the patient. Not for-profit companies run by sociopathic executives. (Although in this case we are talking about state-run Medicare using private companies’ AI to make the determination.)
D_C@sh.itjust.works · 79 pts · 336d
Well I'm sure it'll be all fair and definitely not
DENIED
DENIED
DENIED
DENIED
DENIED CHACHING
DENIED CHACHING
CHACHING
CHACHING
CHACHING
Oh no, that'll deffo not happen. No way!!!
UnderpantsWeevil@lemmy.world · 30 pts · 336d
Going to be weird when they let Luigi Mangione out and the head of CMS immediately unalives.
ThisGuyThat@lemmy.world · 28 pts · 336d
We can say die.
can@sh.itjust.works · 13 pts · 336d
We can, but it's getting deeper than that. Algorithmic censorship is leading to changes in the real world English language.
ThisGuyThat@lemmy.world · 17 pts · 336d
Die
fartographer@lemmy.world · -4 pts · 336d
Unalive
I'm
doingdownvoting mypartpostPalmTreeIsBestTree@lemmy.world · 8 pts · 336d
Die, suicide, rape, fuck, shit…
Feathercrown@lemmy.world · 2 pts · 336d
https://youtu.be/B_36H1rs1x8
fartographer@lemmy.world · 1 pts · 336d
Fuck shit stack
Maeve@kbin.earth · 2 pts · 336d
https://grammarist.com/wp-content/uploads/Grammarist-Featured-Image-V12-1200-PX-1-1024x512.png
can@sh.itjust.works · 2 pts · 336d
Would work better if there were only one
fartographer@lemmy.world · 2 pts · 336d
-dies-
Lost_My_Mind@lemmy.world · 11 pts · 336d
No no, it doesn't say Die Bart Die. It's french, for The Bart The!
DeadDigger@lemmy.zip · 10 pts · 336d
It's not french it's German!
Mirshe@lemmy.world · 9 pts · 336d
This is just wealth transfer to keep another AI company afloat. Most of them live and die on investor cash, and never turn a profit.
CheeseNoodle@lemmy.world · 2 pts · 335d
Given the answers we know they want this should be a pretty profitable business.
Done, and my entire company infastructure is a raspberry pi.
DragonTypeWyvern@midwest.social · 60 pts · 336d
kryptonianCodeMonkey@lemmy.world · 56 pts · 336d
AI companies going to start generating fake claims and denying them for rewards, I guarantee it.
ameancow@lemmy.world · 13 pts · 336d
kent_eh@lemmy.ca · 32 pts · 335d
Is there a name for the next step beyond perverse incentives?
Because that's where we are now.
theneverfox@pawb.social · 17 pts · 335d
Kleptocracy. They just aren't bothering to hide the fact that they're selling off the government for parts anymore
WorldsDumbestMan@lemmy.today · 1 pts · 334d
They are ethically clensing America
theneverfox@pawb.social · 3 pts · 334d
They're trying... But it's almost performative. I calmed down a lot when they complied with the orders to shut down alligator Auschwitz, now we've got ICE whining about how no one likes them, people aren't coming to their hearings to get picked up, and all that bullshit about denaturalization seems to have been dropped
Don't get me wrong, it's still horrible, we need to fight it, and we need to disband ICE and have trials when this is all over... But it's not the defining aspect of this administration
Those tents and cages in the Everglades cost hundreds of millions to set up, and probably a comparable amount to tear down. Money that was set aside for disaster recovery. The majority of that money went in someone's pocket
And that's the real defining aspect of the administration. They're fascist enough to do fascism, but they're too busy looting the government for profit to commit to it
gndagreborn@lemmy.world · 6 pts · 335d
Willful hatred
BussyGyatt@feddit.org · 3 pts · 335d
perverse intentions?
Pistcow@lemmy.world · 32 pts · 336d
Here's your head of Medicare.
Good Ol' Doctor Oz.
Big profile you should be able to track him down easy in the wee hours of the morning to ask some questions as any good citizen of someone representing their interests.
https://www.hhs.gov/about/leadership/mehmet-oz.html
can@sh.itjust.works · 21 pts · 336d
I'm still incapable of fully accepting that's real.
mrgoosmoos@lemmy.ca · 10 pts · 336d
ok, as a non american, that's not a real government site, right? this is a good joke?
can@sh.itjust.works · 12 pts · 336d
Trump likes to appoint people he sees on TV.
Pistcow@lemmy.world · 2 pts · 336d
Bingo
umbrella@lemmy.ml · 30 pts · 336d
buddascrayon@lemmy.world · 30 pts · 335d
Yeah cause people on medicare aren't likely to need steroid shots for things like joint pain or anything. Anyone 65 and older should start saving their money now to pay for their steroid shots that are going to start costing them a couple hundred bucks a pop.
cheers_queers@lemmy.zip · 26 pts · 335d
As someone who lives with constant pain, calling pain relief of any kind "wasteful" enrages me. See if pain relief has "little benefit" when im done with you, mufucka
hector@lemmy.today · 3 pts · 335d
If payments out of pocket were reasonable maybe we are charged like a hundred times what everybody elsein the world pays.
Investors like private equity have taken over Health Care and are extracting the life savings of baby boomers for medical care that used to cost a reasonable amount of money.
pleaseletmein@lemmy.zip · 30 pts · 336d
I fucking hate the future, man.
Goodmorningsunshine@lemmy.world · 4 pts · 335d
This is why I'm so thankful for mortality and chose not to have children. Please, universe, let reincarnation not be a thing.
WorldsDumbestMan@lemmy.today · 1 pts · 334d
Afraid it is. But you will never be allowed to understand.
nomy@lemmy.zip · 2 pts · 334d
Surprise! You're dead!
Guess what? It never ends! Hahaha!
ThePantser@sh.itjust.works · 28 pts · 336d
So they will approve more claims to avoid paying, right... Right?
betterdeadthanreddit@lemmy.world · 14 pts · 336d
Yes, I said, lying.
The machine won't let me get treatment for the thing that makes me narrate my actions, I explained with a weary sigh.
Lost_My_Mind@lemmy.world · 6 pts · 336d
Your sex life must be documented. Especially if you have kinks!
billwashere@lemmy.world · 28 pts · 335d
You don’t need AI for that….
grainOfSalt@sh.itjust.works · 27 pts · 335d
So basically the opposite of what Obama or Biden did as usual https://arstechnica.com/health/2024/11/biden-proposes-guardrails-on-health-care-ai-upping-weight-loss-drug-access/
buddascrayon@lemmy.world · 20 pts · 335d
This is the point. They want to erase any legacy either of them left. Trump is a petty little asshole who is still mad that Obama made fun of him once.
Blackmist@feddit.uk · 26 pts · 336d
So, reject everything and let appeals sort it out.
We got you fam.
Whats_your_reasoning@lemmy.world · 10 pts · 335d
And who knows how long that'll take. While we're waiting to see if your pain is considered valid enough to warrant relief, here's a wooden spoon to bite down on.
Blackmist@feddit.uk · 9 pts · 335d
The wooden spoon is $800.
Mediocre_Bard@lemmy.world · 3 pts · 335d
PlantDadManGuy@lemmy.world · 7 pts · 336d
I'm a feeling a hungary for summa those Italian meat balls delivered at 1200fps...
RizzRustbolt@lemmy.world · 26 pts · 336d
In the radio business they call that "payola", and it is very much illegal.
TuffNutzes@lemmy.world · 24 pts · 335d
So bribe the private sector to deny all claims routed through them first for government healthcare and then claim 'gUbmEnT dEAtH pANEls!' are the problem.
humanspiral@lemmy.ca · 1 pts · 334d
The AI models getting paid most the most they deny is private sector grift built in here.
DeathByBigSad@sh.itjust.works · 22 pts · 335d
something something video game character from a nintendo game who's colors are from mixing blue+yellow... 😏
AngryCommieKender@lemmy.world · 11 pts · 335d
Luigi has allegedly already done his part. Mario needs to step up and help his bro out.
hector@lemmy.today · 3 pts · 335d
Need multiplayer.
Feathercrown@lemmy.world · 20 pts · 336d
I've wondered this for a while: Insurance is a contractual obligation on the insurer's part, right? What's stopping me from just suing them for breach of contract rather than going through their appeals process if they illegally deny my claim?
WolfLink@sh.itjust.works · 22 pts · 336d
Probably some terms and conditions you signed as part of the contract
Venus_Ziegenfalle@feddit.org · 19 pts · 336d
The cost of a lawyer that can hope to match theirs. They don't care if it loses them money as long as it deters others from trying the same.
Sunflier@lemmy.world · 11 pts · 335d
Medicaid is a government provision that has no contract that underpins it. With something like United Healthcare, there is a bargained for exchange of mutual consideration (you give $ and UHC provides insurance subject to all the terms and conditions in the contract).
That is not something in Medicaid because Medicaid isn't getting anything in exchange for its health coverage. The government can put whatever restrictions on it that it wants. The benefit comes from the government having one more contribution to the ecconomic system. However, that is too attenuated of a benefit to say that there was a bargained-for exchange.
xia@lemmy.sdf.org · 19 pts · 335d
I guess "death panels" are fine if they are machines?
floofloof@lemmy.ca · 12 pts · 335d
They're fine if they make money for the right billionaires.
nomy@lemmy.zip · 7 pts · 334d
Death panels always existed they just wanted them to be employees at a for-profit.
It's the lack of profit that scares them I guess.
Sunflier@lemmy.world · 18 pts · 335d
Ah! Americans need to be willing to dig deep—really tough it out—to cut costs and save as much money as AI makes possible so that the government can give just 1 more penny to the billionaires. Won't someone please think of the billionaires?
chunes@lemmy.world · 18 pts · 336d
If it makes anyone feel better, they denied everything when it was humans running the show too
ameancow@lemmy.world · 3 pts · 336d
chunes@lemmy.world · -4 pts · 336d
Wow I guess I was just imagining several denials from the past decade then. Silly fucking me
ameancow@lemmy.world · 3 pts · 335d
fedupwithbureaucracy@lemmy.world · 17 pts · 336d
burntbacon@discuss.tchncs.de · 2 pts · 335d
I think someone else mentioned that doc oz is the head of medicare now.
frostysauce@lemmy.world · 1 pts · 335d
PalmTreeIsBestTree@lemmy.world · 16 pts · 336d
What’s the fucking point of paying for it anymore? Might as well not even have it at this point…
Fedizen@lemmy.world · 14 pts · 334d
It should be illegal for anyone but a doctor to deny a claim. This isn't even going to be AI, its just going to be a program that denies everything.
NotMyOldRedditName@lemmy.world · 5 pts · 334d
if(true) { return deny } else { return deny }
phoenixz@lemmy.ca · 4 pts · 334d
They'll still use AI for it though, even just to write the program that just does a single line of code: reject();
mrgoosmoos@lemmy.ca · 14 pts · 336d
what the fuck kind of country looks to save billions of dollars spent on healthcare for their own citizens instead of waste fraud & abuse by the uber wealthy, or the military?
you can have an insanely strong military without the waste & fraud that exists in the US
jumping_redditor@sh.itjust.works · 0 pts · 335d
Because the military is for "protection" and the uber wealthy earned it (by some definition of earned)
HotsauceHurricane@lemmy.world · 13 pts · 336d
This is FUCKING enraging.
Feathercrown@lemmy.world · 12 pts · 336d
I didn't know I still had any faith to lose in the insurance industry. At this point anyone in a management position is undeniably evil, in all senses of the word. I wish nothing but the worst for them.
deathbird@mander.xyz · 11 pts · 336d
That's a fucking idiotic idea.
ameancow@lemmy.world · 11 pts · 336d
FlyingCircus@lemmy.world · 11 pts · 334d
I’m so tired of living under capitalism. Can you all please get some fucking class consciousness so we can get out of this hellscape?
DrSleepless@lemmy.world · 11 pts · 336d
Gross
Soleos@lemmy.world · 10 pts · 336d
Garbage humans in, garbage AI out
AngularViscosity@piefed.social · 10 pts · 336d
So what's the point of having insurance if you can't claim what you need?
Soleos@lemmy.world · 6 pts · 336d
The point is fraud. They give you just enough to think they will cover you when you really need it. And by then, they've already extracted the optimum amount they were gonna get from you.
Almacca@aussie.zone · 8 pts · 336d
The term 'perverse incentive' springs to mind, except there'll be nothing unexpected about the consequences.
jumping_redditor@sh.itjust.works · 2 pts · 335d
the incentives perfectly match the goal
postmateDumbass@lemmy.world · 7 pts · 336d
Wasnt incentivising robots to kill humans supoosed to be prevented by those Azimov laws?
kelpie_returns@lemmy.world · 6 pts · 336d
selokichtli@lemmy.ml · 5 pts · 336d
Fucking bots, they started disallowing us from browsing the web. Sure they'll be more careful with our lives.
finitebanjo@lemmy.world · 3 pts · 335d
Good Job, Luigi! You saved healthcare!
floofloof@lemmy.ca · 4 pts · 335d
The ethics of sabotaging AI are even less murky than the ethics of what Luigi did. We need tech Luigis.
finitebanjo@lemmy.world · 3 pts · 334d
Now we're talking
possiblylinux127@lemmy.zip · 2 pts · 334d
As it turns out murdering a random CEO doesn't fix the deep issues with out healthcare.
CEOs are just cogs in the machine at the end of the day. Investors, the rest of the company leadership and the government are all to blame as well.
It is crazy that it is ok to profit off of denying people care.
finitebanjo@lemmy.world · -2 pts · 334d
TBH mainly just the government. One specific party, even.
Blackmist@feddit.uk · 1 pts · 334d
Violence is like duct tape. If it hasn't solved your problem, you didn't use enough of it.
finitebanjo@lemmy.world · 0 pts · 334d
Just keep hitting your laptop, I'm sure it will turn on again eventually.
Violence can solve a problem if you have the correct targets, maybe.
ninjabard@lemmy.world · 3 pts · 336d
We really need to move to a single payer system when Trump kicks the covfefe bucket.
hitmyspot@aussie.zone · 3 pts · 336d
Will it then be fined when it gets it wrong after manual review? Will the person be compensated too?
Of course what they forget is other AI companies will game it on the other end to add new codes to claim that won't be denied.
yarr@feddit.nl · 2 pts · 335d
Has anyone checked out the fact sheet from CMS: https://www.cms.gov/files/document/wiser-fact-sheet.pdf ?
devilish666@lemmy.world · 1 pts · 332d
Well i guess we need digital Luigi that can DDOS or prompt injecting the hell out of them.
possiblylinux127@lemmy.zip · 1 pts · 334d
What I time to be alive
The only way to actually get decent coverage is to get it though an employer.
humanspiral@lemmy.ca · 1 pts · 334d
This is definitely the wrong "motive structure" for administrative decisions from agency supposed to provide healthcare. Proof of grift as a goal.
By all means, use AI assistance to determine claims validity. But the AI service should be paid per query, or to licence whole model for unlimited use with medicare paying for the computers/gpus. Medicare should be choosing a model that is accurate instead of one that is paid to deny everything, because Homer Simpson's birdy automation can do that ultra cheap.
traceur301@lemmy.blahaj.zone · 5 pts · 334d
Taking claim validity away from the doctor that's actually in charge of the patient's care is already fucked. AI cost cutting doesn't belong in medicine full stop. It shouldn't be a for-profit "industry" in the first place. We're so fucked nobody can even think about this without insane, anti-human framing coloring everything
humanspiral@lemmy.ca · 3 pts · 334d
Private medical insurance is corrupt as starting point. A public health insurance/payer system can still be subject to ineligible or fraudulent claims. Every medical provider demand for money automatically accepted is not the perfect model either. Systems, AI or not, should avoid improper denials is a standard only possible in public health systems.