American health insurance companies have been quietly using AI to auto-deny medical claims with virtually no human oversight? Sounds insane and I don’t know how this is allowed. Cool to people trying to fight back and help patients and clinics with free AI tools, but I don’t know how this will succeed, because the big insurance companies have lot more money and better
Big Insurance Uses AI to Quickly Deny Claims, One Man Fights Back with AI App That Quickly Appeals
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How is this worse than hiring an actual doctor to deny 500 claims an hour?
It doesn’t sound insane at all, just inhumane. And of course this is allowed. It is still very far from the most illegal and unethical activities healthcare providers have done, have been able to do and even at times encouraged to do.
Submission statement: If AI continues to be used by health insurance companies to automatically deny claims, the future of healthcare could shift dramatically potentially reducing costs for insurers but increasing suffering for patients. We should discuss whether AI in healthcare should be regulated differently, and how competing AI tools from patient advocacy groups might balance the power. Could this lead to an arms race between corporate and public-interest AI, and what would that mean for medical ethics, privacy, and healthcare equity in the next decade?
People are going to need an Ai agent that communicates on their behalf. It will be the only way to level the field of consumer to business and will probably make things happen more efficiently in most cases. Edge cases will get harder and harder to fix though.
Holy God damn fucking shit am I glad to live in a country that doesn’t have this kind of crap to deal with.
My healthcare is decided by my doctor, and will be for the foreseeable future. If they say I need something, the only challenging block is how available it is and what the way times look like, and when things are serious, the way times get dropped off real fast.
Health care for profit is such an insane and inhuman thing to be talking about in a society with this much wealth.
And the fact that it’s getting worse is just mind-boggling. Sorry America, I think you’re doomed.
The most likely next step is for hospitals to begin rolling out AI nurses, which will take over seeing most patients, diagnosing, and prescriptions. There will be one doctor kept on staff whose job is to rubber-stamp whatever the AI says. If they say “no” whenever the AI writes a set of prescriptions guaranteed to kill the patient, they get fired. It’s even possible the standards of care will be rewritten to say that following AI instruction is necessary and defying it could be grounds for losing a medical license.
Silicon valley will kill us all for a buck if we let them.
If insurers are using AI why aren’t there guardrails? And better appeal rights? I’m glad there’s free AI tools like Counterforce Health out there, but seriously, why is the government asleep here in not properly regulating health insurance companies?
The lengths we go to for useless middlemen to get rich
Its funny/scary/sad to think about “AI versus AI” this is going to turn into. I guess the positive side is patients aren’t getting caught in crossfire. Both an uplifting story that these people at Counterforce Health created a free AI to help patients, but also a frustrating story the insurance companies are doing this in the first place.
How about you ask how many of these denials are because of errors on the claims submitted? Just because a claim is denied doesn’t mean it was filed correctly. If providers think a claim denied incorrectly all major insurance companies have a provider line where they can speak to a live person to figure out what happened.
Claims can deny because
– prior auth was required and none was requested
– prior auth approved for a different code and patient received a different service either because of error filing PA for correct procedure or doctor determined a different thing would benefit the patient. Claim denied yes, but a PA can be changed for many reasons including this scenario
– doctor out of network (solved with PA)
– patient was with a different ins co when they were seen
– claim sent to incorrect state for processing,when seen out of state or just in error
– Patient info on claim doesn’t match (name/DOB/ Medicare or Medicaid#)
– other active insurance is primary and claim was not sent with proof that primary plan processed the claim first
– claim sent after the filing limit which can be 1-2 years for medical claims depending on the company
That is really the bulk of the denial reasons and what I had to deal with as a rep that takes calls from call centers that medical offices hire to ask for the status on claims. I feel that this is in order of most to least common reasons claims get denied.
Are insurance companies greedy? They can be, but they aren’t the ones charging you full price and sending you to collections, thats hospitals and doctor offices. If an insurance company handles Medicare/Medicaid claims the claims have to be fucking spot on. These ads about how quickly an insurance company denies claims are annoying because they choose to not give any context about 1 how many are denied due to errors on the claim and 2 how many claims these companies get in a day. I assume they get a bible’s worth of claims every 40 minutes per state on a busy day, for both HMO and PPO plans. Ever wonder why they say to allow up to 7 days for a claim to process? Eliminate AI and that will change to whatever happens happens.
Queue the ballooning of unpaid medical debt increase (like its not already high) and subsequent legislation that makes unpaid medical debt a legitimate cause to strip someone of their citizenship and deported
Their new tactic is to get you set up with a health coach and among trying to get you to reveal your health details, they ask for your permission to curate your generic data. They want to build a close relationship so that they can get your health info directly and using AI they will black list you if they deem you expensive.
They are desperate right now because they are on the bubble. Insurance is not long for this world.
AI is advancing us towards cures. When we start curing things then we need insurance less. Imagine how much money the insurance company loses when we cure kidney disease. When we cure cancer that may be what pushes them into bankruptcy.
Insurance is not long for this world.
Cars and homes are going to be cheaper to repair/replace and robotics may make that possible without labor.
I am excited for the world where insurance is no longer a thing because we have solved our problems.
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all the rules that apply to normal good ethical people never apply to insurance companies.
discrimination laws? don’t apply. consent? nope. Honouring an agreement that you’ve both signed? also nope.
They can basically do whatever they want.
Yeah, they’ve been doing this already. I’ve had to call my insurer and scold them for practicing medicine without a license. (They tried to tell us my wife didn’t need her meds as they’re “too similar.” )
Well her specialist prescribed it, can you tell me what it’s for and why? Why are you telling me what we can and cannot access? They prescribed it in accordance with the plan. It’s covered, the doctor submitted the prior authorization. This is all red tape bullshit because the CEO needs another yacht.
I’m not doing this every three months, figure out what the problem is and let me know. Bc I had no idea what these medications are until the doctor wrote the prescription. I can’t walk into a pharmacy and demand pills I have no script for.
They tried to blame the pharmacy. But the tech was Already ahead of them as they encouraged us to call. And said there was no reason for them to do this. So, again it’s all bullshit. You have to escalate it to someone who can help.
Thank you, US citizens, for testing this for us here in Europe. We will watch you, see the problems, and then just not do it because it would be way to expensive to get through the EU legal system.