‘Make your health insurance company cry’: One woman’s fight to turn the tables on insurers
‘Make your health insurance company cry’: One woman’s fight to turn the tables on insurers
Sick of the lengthy process of battling insurance denials to get companies to pay for her medical care, Holden Karau decided to fight back like an engineer: She built an AI program to automate the process.
"... The “dirty secret” of the insurance industry is that most denials can be successfully appealed..."
Interesting idea, but I imagine it suffers from similar issues to writing legal opinions: by signing your name to it, you're swearing that it's all true. Given AI's propensity for making things up, you need to check everything.
I wouldn't be surprised if 'knowingly filing a false appeal' is a reason to boot you off the plan in the first place.
57It's still a lot easier to review and understand something you weren't able to write than to also write that same thing without knowing how to write it.
28Indeed. Just need to remember that AI can and will hallucinate entire studies or court cases into existence.
1
by signing your name to it, you’re swearing that it’s all true.
Lawyers too use qualifiers like 'To the best of our knowledge' and 'in our studied opinion' to indicate that opinions may differ. That's why judges exist, and some of them are -so reasonable- that they will accept that people cannot be expected to decide whether a hospital's decision to operate -immediately- is not good enough.
These US 'insurance' companies are in the business of making money from people's health problems. In MOST OF THE CIVILIZED WORLD that's not how health-care works. We, the people of the US, let the system get rigged this way ... we have to fix that. Permanently.
2I think when you use AI to write the claim and there turn it to be errors even after you checked it, it could still be a case of negligence. Like, not that I think it necessarily should be, but I can see that one could make the argument.
1
It’s free for users, though she might eventually charge for added services like faxing appeals.
She should sell the home addresses of health insurance executives.
And golf clubs. She should definitely sell golf clubs.
42The smallest child's aluminum bats are much much more reliable for more than a single swing, and follow through and reset are magnitudes quicker.
16I used to carry what I called a "cracker whacker," on food deliveries. It was a miniature Louisville Slugger baseball bat. I cut off the last ¼" and used a ⅓" drill bit to create a cavity inside. I then dropped in a 3.5 lb round bar of lead that had about 2" of room on one end to shift back and forth as you swung the bat. I then resealed the bat using the cap I took off, some wood epoxy and 4 finishing nails, just in case.
That thing would easily have shattered a kneecap if I had ever had to actually use it, rather than just brandishing it.
19
Unrelated fact, but on the topic of golf clubs, they are pretty slender. I think they may bend if you hit a large object with them.
5That's why Casey Jones traded the golf club for a hockey stick in the first movie. At which point he opened a can of whoop ass all over the foot clan thugs.
7
Gave it a go. Seems like it has potential. I'm still working through an appeal. My wife ended up in the ER in May and was directly admitted to the hospital for emergency surgery. Ten days afterwards we received a letter from the insurance company saying they had decided it wasn't medically necessary so they wouldn't be paying the $67k bill.
It has been a journey trying to get the appeal together. I had hoped the hospital would at least assist with a letter from one of the many physicians that attended her, but nope. We got laughed at by the surgeons office and told condescendingly "Yeah, that's not how any of this works. "
My biggest concern from the AI generated appeals are being able to confirm the statements it is making isn't just a LLM hallucination. As a lay person, much of the things necessary to make an argument are paywalled out of reach. For example, the insurance company cited the "2023 InterQual criteria for Surgical Conditions" as the reason why they are denying it. The AI appeal that was generated states that per the 2023 InterQual criteria for surgical conditions that hospitalization was medically necessary.
The only way it seems you can actually get access to InterQual is as a medical provider / payer.
28.... I thought most people actually just appealed most denials???
I was pretty sure this was already common knowledge?
90% of the time what happens is that you call up your insurance for some shit like hey my jaw be broken as fuck, and they go "nah thats cosmetic" and then you spend 2 weeks fighting with them until they cave and actually cover it.
26you call up your insurance
They're "solving" this problem with less agents or customer service staff, automating the process so you have a robot to deal with that doesn't ever seem to understand what you're saying, and can't get you to the right place. Basically make it as hellish as possible to even get your issue reviewed. Then, they stone wall you and don't take yes for an answer no matter what
21ah yes, this should be illegal, i don't care how much money it saves.
11
...This is just a network switch/router.
22You sound like one of them fancy book reading types you get the fuck out! Lol
13She's turning into Lain.
2Also looks like a few enclosures on a lower shelf (which could be anything) but technically you can run WAN-exposed servers on most routers, not that it’s advised just possible.
2
In an ideal
worldcountry, we would have a different system, but we don’t live in an idealworldcountry, so what I’m shooting for here is incremental progress and making theworldcountry suck a little less,”.It’s a good article. Don’t let that American exceptionalism creep into it.
17Yeah, honestly the appeal is a standard step in the bottom surgery process in the states. I know one lady who had to explain to her insurer why removal of the penis was a necessary step in her vaginoplasty.
11We love some good news to start the day
11Hehe her dog is a donut hole with a PhD.
7I think the PhD may be honorary in Timbit's case. Though I suppose if she has a doctorate as well, she may have used him as a rubber duck, and therefore given him credit on her Doctorate Thesis, thereby granting him a doctorate as well? I dunno if that would work.
3
You go human
6Gender affirming surgery can be the opposite of health care, supporting what neuro-diversity thinks it needs is often harmful to that individual. For example, you wouldn't prescribe unlimited sleep for someone with narcolepsy.
The states has bad healthcare but this is a misleading article, and not necessarily in support of patient health.
-92Maybe take that transphobic take to a community that doesn't have LGBTQ+ resources as a pinned thread.
39Here's your reminder about gender affirming treatments like testosterone pills and jawline surgery and hair transplants: Elon got all three
33And i think he eats bulking powders enough for Arnold, but forgot the training.
13Ha I wouldn't use Elon Musk as an example of someone who makes good decisions.
2
Okay, i happen to actually have narcolepsy & be gender nc, and have a trans partner, i feel like i can speak with some authority on this.
Gender affirming surgery can be the opposite of health care
Every surgery can be, but gender affirming care is one of the least regretted surgeries in existence. By opening this way, you frame the argument as different for trans healthcare. Its not.
We're also not children. Dont infantilize trans people. We have the same right to make choices others don't understand, just like cis folks can.
And narcolepsy is a chronic inability to get delta wave sleep. Extra sleep is absolutely treatment. I can see what your getting at, but you're choosing examples you don't understand and misinforming people.
28I think we agree about surgery, which is kinda the point. And because of that trans healthcare is not different than other health care, that's also the point.
And I completely agree extra sleep can be used to treat narcolepsy, but it can also make things worse, which is why you need to look at all the options, balence etc.
Medicine is rarely a simple matter of one treatment for all issues.
-1
An opinion that ignores all actual research.
Gender affirming surgery helps 99% of people who receive it! So sure, technically, there's a tiny minority who regret it. More people regret Lasik and boob jobs, should we ban those too? Many people regret a night out drinking, how about we ban that too. Drinking causes way more harm than giving estrogen or testosterone pills to folks.
On the other hand, I like that my friends have the freedom to express themselves any way they want. They aren't hurting anyone so let's let them be free to wear whatever clothes they want and take whatever hormones they want.
So join the side of American freedom and let's stop policing what clothes people wear or what name they use.
22It's about risk.
I don't think many people are seriously suggesting banning gender affirming surgery, I certainly am not.
But to your point; yes it would be better if more thought, research, alternatives and wholistic health was put into LASIK, or alcohol, or even just food.
Both individuals and society would benefit, which is why many governments make medicine essentially free.
-2
Is prescribing sleep surgery?
8No but its giving the neuro diversity what it wants, which isn't always bad, but can worsen an individuals health.
You wouldn't prescribe complete isolation as a treatment for social anxiety, except in very extreme and uncommon cases.
-1
Like hair plugs? Or Viagra?
2Kinda, but more dangerous and political
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There's been quite a few reports for this comment, I don't know if it's right to remove it, since to me it just comes off as misinformed more than anything and I believe seeing the rebuttals here, coupled with the original comment, is actually more helpful and constructive to the conversation.
Even so, I'll let the reporters decide if they still wish to hide this comment.2As someone with IH/N2 (idiopathic hypersomnia/narcolepsy type 2) extra sleep doesn't do shit.
1Exactly.
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