AI Battle Between Insurers and Hospitals Jacked Up Patient Prices by Nearly $1 Billion
https://www.commondreams.org/news/ai-in-healthcare-billing
AI Battle Between Insurers and Hospitals Jacked Up Patient Prices by Nearly $1 Billion
https://www.commondreams.org/news/ai-in-healthcare-billing
12 Comments
Promised: AI curing cancer and predicting rare diseases.
Delivered: AI finding 4,000 new ways to charge you $300 for a secondary anemia diagnosis without giving you a transfusion.
The Blue Cross/Blue Shield Association says that AI is already driving up healthcare costs, as hospitals use the technology to find instances where they can bill more for the same level of care.
>More than 60% of hospital systems are now using AI-enabled technologies that can scan lab results and electronic records to identify secondary diagnoses, which could move a patient into a higher-severity, higher-reimbursement billing category. For the analysis, researchers looked at secondary diagnoses like anemia following major bowel surgery.
>Researchers found secondary diagnoses that shifted claims into a higher-reimbursement category accounted for 70% — roughly $650 million — of the increased costs for Blue Cross and Blue Shield (BCBS) companies from 2023 to 2025.
https://www.bcbs.com/about-us/association-news/bcbsa-analysis-ai-coding-tools-affects-healthcare-costs
my app auto-denied a basic blood test in literally three seconds last month. glad my premiums are paying for them to build faster rejection bots.
Insurance companies get a lot of hate but the hospitals maximizing charges is a big part of the problem too
I love the future.
insurance companies should be held criminally liable for any harm as a result of this crud
Is this really jacking up patient prices – at least “today”? In the noted scenario, AI is being used to optimize coding, which increases the reimbursement that the medical care entity receives from the insurer. But the entity is not increasing their cost to the patient – they can only charge for services rendered. Now I understand that the insurance company can counter by subsequently raising patient rates next year based on higher costs paid out to care providers. I don’t work in rev cycle management or coding but wouldn’t this be the case?
No sh:t
Just let doctors practice medicine
The article’s $942 million figure comes from a Blue Cross analysis, so I’d want an independent check before treating every added diagnosis as improper. Still, the gap they describe is worth auditing: more secondary diagnoses and higher reimbursements without a matching change in care. The billing incentives deserve as much scrutiny as the software.The article’s $942 million figure comes from a Blue Cross analysis, so I’d want an independent check before treating every added diagnosis as improper. Still, the gap they describe is worth auditing: more secondary diagnoses and higher reimbursements without a matching change in care. The billing incentives deserve as much scrutiny as the software.
Insurance AI refuses payments for diagnoses they don’t like. It will also deny common procedures without a human ever reading physician notes. They can toggle denial rates for the AI without anyone ever viewing all medical records you doctor might send.
I guarantee you insurance AI that avoids caring for patients involves higher dollar amounts than hospitals trying to get patients cared for.
American healthcare be like “pay us hundreds of dollars a month so we can reject every health screening and treatment you need. And then give us more money.”
Single payer was supposed to bring the death panels but this for-profit system has taken us from sociopath CEOs and humans denying and delaying you to death and bankruptcy to now using advance technologies to do it. Oh well, if it’s the robot making the choices what can you do?