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AI cannot be used to deny health care coverage, feds clarify to insurers

arstechnica.com

11–20 of 55 posts

Re: AI cannot be used to deny health care coverage, feds clarify to insurers

#11
post #2

AI has been used to deny healthcare coverage for generations, we just called it actuarial science

All regulations involving AI just make me wonder how the hell anyone can draw a line between statistics and whatever ""AI"" means in 2024. Getting angry at the moment every time i see "AI" because the terminology is just nonsense to me. Is it just neural networks now?

Re: AI cannot be used to deny health care coverage, feds clarify to insurers

#12
post #3

Instead, a physician working for the insurance company will use some sort of GPT to come up with an excuse to deny care and then they will write that up in their own words to deny care.

I think that’s ok from the perspective of the discussion at hand because we are still talking about an actual human’s terrible decision having their name attached to it. I think the system used to deny care being comically broken is a wholly different issue.

Re: AI cannot be used to deny health care coverage, feds clarify to insurers

#13
post #9
post #2

AI has been used to deny healthcare coverage for generations, we just called it actuarial science

What? I tell my dad that the funny spreadsheets he made in the 60s are AI now.

Well, the only significant difference between "funny spreadsheets" and ML models is the size of data you can feed them.

Re: AI cannot be used to deny health care coverage, feds clarify to insurers

#14
post #3

Instead, a physician working for the insurance company will use some sort of GPT to come up with an excuse to deny care and then they will write that up in their own words to deny care.

I think that’s ok from the perspective of the discussion at hand because we are still talking about an actual human’s terrible decision having their name attached to it. I think the system used to deny care being comically broken is a wholly different issue.

Insurers now refuse to release the name of the contracted doctor who made the denial.

Re: AI cannot be used to deny health care coverage, feds clarify to insurers

#15

How about just prohibiting them from denying coverage at all , except for bona fide fraud? So much of the rot of the healthcare system stems from this broken regulatory approach of thinking that corporate bureaucrats will somehow "manage" care better than patients and doctors can. These "insurance" companies should be relegated to a purely financial role, as a basic table stakes reform.

Because everything is misaligned.

There’s no reason to get a MRI for a basic headache, but if it’s free, why not?

And attempts to solve this just muddle it worse, but some could help - nobody is going to voluntarily take insulin, for example, so just make those impossible to deny.

Re: AI cannot be used to deny health care coverage, feds clarify to insurers

#16

How about just prohibiting them from denying coverage at all , except for bona fide fraud? So much of the rot of the healthcare system stems from this broken regulatory approach of thinking that corporate bureaucrats will somehow "manage" care better than patients and doctors can. These "insurance" companies should be relegated to a purely financial role, as a basic table stakes reform.

If the US could get costs down to levels of other developed countries, we could approve everything and still afford it.

As of now, medical care in the US is about 2x-3x the cost it is in other developed countries.

Re: AI cannot be used to deny health care coverage, feds clarify to insurers

#17
post #3

Instead, a physician working for the insurance company will use some sort of GPT to come up with an excuse to deny care and then they will write that up in their own words to deny care.

I have a hard time figuring out how those in the health insurance industry get sleep at night.

Re: AI cannot be used to deny health care coverage, feds clarify to insurers

#18
post #16

How about just prohibiting them from denying coverage at all , except for bona fide fraud? So much of the rot of the healthcare system stems from this broken regulatory approach of thinking that corporate bureaucrats will somehow "manage" care better than patients and doctors can. These "insurance" companies should be relegated to a purely financial role, as a basic table stakes reform.

If the US could get costs down to levels of other developed countries, we could approve everything and still afford it. As of now, medical care in the US is about 2x-3x the cost it is in other developed countries.

cost of living though

Re: AI cannot be used to deny health care coverage, feds clarify to insurers

#19
post #16

Earlier quoted context omitted.

If the US could get costs down to levels of other developed countries, we could approve everything and still afford it. As of now, medical care in the US is about 2x-3x the cost it is in other developed countries.

cost of living though

Maybe in some cases, though overall cost of living in Australia is slightly higher than the US while still spending about half what we do on medical costs.

Re: AI cannot be used to deny health care coverage, feds clarify to insurers

#20
post #15

How about just prohibiting them from denying coverage at all , except for bona fide fraud? So much of the rot of the healthcare system stems from this broken regulatory approach of thinking that corporate bureaucrats will somehow "manage" care better than patients and doctors can. These "insurance" companies should be relegated to a purely financial role, as a basic table stakes reform.

Because everything is misaligned. There’s no reason to get a MRI for a basic headache, but if it’s free, why not? And attempts to solve this just muddle it worse, but some could help - nobody is going to voluntarily take insulin, for example, so just make those impossible to deny.

> There’s no reason to get a MRI for a basic headache, but if it’s free, why not?

Because an MRI is an exhausting, irritating experience.

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