• NatakuNox@lemmy.world
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      11 days ago

      The fact that there’s shares to be had for denying care is crazy. They know denying care is their business! Meaning that the money they didn’t spend on your care doesn’t go back into the pot for everyone in your group, they are pocketing some of the money whenever they deny someone. That’s it. They don’t help anyone but themselves. There should be a requirement that insurance companies publicly announce how much money they made from denying care

  • D_C@sh.itjust.works
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    11 days ago

    Well I’m sure it’ll be all fair and definitely not
    DENIED
    DENIED
    DENIED
    DENIED
    DENIED CHACHING
    DENIED CHACHING
    CHACHING
    CHACHING
    CHACHING

    Oh no, that’ll deffo not happen. No way!!!

    • ameancow@lemmy.world
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      11 days ago

      That’s the best possible outcome.

      The more likely outcome is a lot of people are going to die or suffer needlessly.

  • ☂️-@lemmy.ml
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    11 days ago

    so no healthcare for anyone anymore? just insurance companies paying themselves now.

  • kent_eh@lemmy.ca
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    10 days ago

    Is there a name for the next step beyond perverse incentives?

    Because that’s where we are now.

  • billwashere@lemmy.world
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    10 days ago

    You don’t need AI for that….

    
    #!/usr/bin/env python3
    
    def main():
        try:
            _ = input("Enter reasoning for claim: ")  # read but ignore the input
            print("denied")                # always respond "denied"
        except (EOFError, KeyboardInterrupt):
            # Even if input is interrupted, still respond "denied"
            print("denied")
    
    if __name__ == "__main__":
        main()
    
    
  • buddascrayon@lemmy.world
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    10 days ago

    Officials assert that the AI tools will only be used to judge claims for about a dozen different types of procedures it deems to be wasteful and providing little benefit, including steroid shots to relieve pain, per the NYT.

    Yeah cause people on medicare aren’t likely to need steroid shots for things like joint pain or anything. Anyone 65 and older should start saving their money now to pay for their steroid shots that are going to start costing them a couple hundred bucks a pop.

  • TuffNutzes@lemmy.world
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    10 days ago

    So bribe the private sector to deny all claims routed through them first for government healthcare and then claim ‘gUbmEnT dEAtH pANEls!’ are the problem.

    • humanspiral@lemmy.ca
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      9 days ago

      So bribe the private sector to deny all claims routed through them first

      The AI models getting paid most the most they deny is private sector grift built in here.

    • buddascrayon@lemmy.world
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      10 days ago

      This is the point. They want to erase any legacy either of them left. Trump is a petty little asshole who is still mad that Obama made fun of him once.

  • Feathercrown@lemmy.world
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    11 days ago

    I’ve wondered this for a while: Insurance is a contractual obligation on the insurer’s part, right? What’s stopping me from just suing them for breach of contract rather than going through their appeals process if they illegally deny my claim?

    • Venus_Ziegenfalle@feddit.org
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      11 days ago

      What’s stopping me from just suing them for breach of contract rather than going through their appeals process if they illegally deny my claim?

      The cost of a lawyer that can hope to match theirs. They don’t care if it loses them money as long as it deters others from trying the same.

    • Sunflier@lemmy.world
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      10 days ago

      What’s stopping me from just suing them for breach of contract rather than going through their appeals process if they illegally deny my claim?

      Medicaid is a government provision that has no contract that underpins it. With something like United Healthcare, there is a bargained for exchange of mutual consideration (you give $ and UHC provides insurance subject to all the terms and conditions in the contract).

      That is not something in Medicaid because Medicaid isn’t getting anything in exchange for its health coverage. The government can put whatever restrictions on it that it wants. The benefit comes from the government having one more contribution to the ecconomic system. However, that is too attenuated of a benefit to say that there was a bargained-for exchange.