AI cannot be used to deny health care coverage, feds clarify to insurers
1–10 of 55 posts
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#2AI has been used to deny healthcare coverage for generations, we just called it actuarial science
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#3Instead, 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.
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#4I don’t see how we can use ai and not have it generate new biases.
I also feel like biases have been baked into insurance data in a discriminatory way for a long time — think about how much car insurance is for a 16 year old boy.
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#5> 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"
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#6Instead, 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 effects may be. Screw them all, i wish them nothing but the worst
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#7I don’t see how we can use ai and not have it generate new biases. I also feel like biases have been baked into insurance data in a discriminatory way for a long time — think about how much car insurance is for a 16 year old boy.
Yes but consider the alternative - how will we eliminate bias without it?
Having worked in medical billing, it is very scary how medicine as an applied science is carrying around a huge ball and chain of “insurance hasn’t figured out that their medical model is decades out of date.”
Big, complex, data intensify problems are not going to be solved by an army of humans on legacy ERPs.
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#8How 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.
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#9AI 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.
Re: AI cannot be used to deny health care coverage, feds clarify to insurers
#10How 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.
[dead]