Earlier quoted context omitted.
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.
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AI cannot be used to deny health care coverage, feds clarify to insurers
21–30 of 55 posts
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#22Instead, 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.
as a med student, those guys are an embarrassment to us all. I had to deal with those guys to get my insurance to cover recombinant antibodies for the treatment of several autoimmune diseases. They haven’t practiced clinically for a decade, haven’t kept up with research ever since they left residency, but still don’t see any problem with denying anything but the cheapest immunosuppressant, no matter how bad the side…
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Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#23Earlier quoted context omitted.
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.
Yes and if your doctor tells you that you need to do one will you argue?
My understanding is that we’re already “over testing”, though would defer to someone with a citation on the topic.
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#24How 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.
Standard "insurance" generally includes copayments for services, sometimes even percentage based. Insurance companies would obviously adapt to such a reform, and my entire point is to align the incentives better. Over the long term, "insurance" companies operating on a cost-plus basis don't even really want to keep costs down, rather denials stem from needing to make sure any payouts are bureaucratically justifiable.
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#25Earlier quoted context omitted.
> 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.
Yes and if your doctor tells you that you need to do one will you argue? My understanding is that we’re already “over testing”, though would defer to someone with a citation on the topic.
Yes, obviously you should "argue" and require an explanation of the doctor's reasoning. I just literally rejected doing an MRI this past weekend, in an emergency context, that would have been financially "free". The things it might have found were already disimplied by bloodwork, or were rare with no treatment options, and in my opinion the amount of iatrogenic harm from the procedure would have been unjustified.
A patient or trusted advocated needs to be involved in a patient's own care, and the current "insurance" system does a great job at destroying this as doctors focus on "insurance" companies and associated bureaucracy as decision makers rather than patients. IMO this is precisely where the request to do an MRI was coming from in the first place - bureaucratic ass-covering.
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#26Earlier quoted context omitted.
Yes and if your doctor tells you that you need to do one will you argue? My understanding is that we’re already “over testing”, though would defer to someone with a citation on the topic.
Yes, obviously you should "argue" and require an explanation of the doctor's reasoning. I just literally rejected doing an MRI this past weekend, in an emergency context, that would have been financially "free". The things it might have found were already disimplied by bloodwork, or were rare with no treatment options, and in my opinion the amount of iatrogenic harm from the procedure would have been unjustified. A p…
What harm is caused to your body by an MRI?
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#27Earlier quoted context omitted.
Yes, obviously you should "argue" and require an explanation of the doctor's reasoning. I just literally rejected doing an MRI this past weekend, in an emergency context, that would have been financially "free". The things it might have found were already disimplied by bloodwork, or were rare with no treatment options, and in my opinion the amount of iatrogenic harm from the procedure would have been unjustified. A p…
What harm is caused to your body by an MRI?
Placing an IV after they had already botched it three times, living on lactated Ringer's instead of real food for the better part of a day, IV sedation anesthesia and its possible complications, (I didn't investigate side effects of the contrast), and the further destruction of bodily autonomy and resulting lack of alertness that comes from all those.
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#28Earlier quoted context omitted.
What harm is caused to your body by an MRI?
Placing an IV after they had already botched it three times, living on lactated Ringer's instead of real food for the better part of a day, IV sedation anesthesia and its possible complications, (I didn't investigate side effects of the contrast), and the further destruction of bodily autonomy and resulting lack of alertness that comes from all those.
Yikes. Seems like a pretty serious MRI. Good luck.
On one hand, this defensive practice of medicine is objectionable. On the other, it only exists because people like to sue providers when outcomes are bad. I’m glad you had a good outcome.
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#29AI 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?
"Statistics" = models with interpretable decision outcomes
"AI" = models without
It's just a little bit easier to hold someone accountable for a logistic regression with predictive bias than for a neural network with similar issues.
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#30> In an example involving a decision to terminate post-acute care services, an algorithm or software tool can be used to assist providers or MA plans in predicting a potential length of stay, but that prediction alone cannot be used as the basis to terminate post-acute care services. So, the Random Forest can say, "No coverage", just so long as the human hits "Accept computer recommendations"
As long as it spits out a p-value and the human decides it looks pretty small.