https://www.homecaremag.com/news/lawsuit-accuses-humana-using-ai-deny-post-acute-care
For five years, I provided back office operations supports to mental health therapists. A large part of what I did consisted of trying to get insurance companies to pay for medically necessary therapy visits.
Those visits included the mom who had suffered traumatic abuse resulting in frightening flashbacks that left her unable to move, or even talk. The child who had watched the murder-suicide of her parents. And too many other situations.
Sometimes, the client was forced to pay out of pocket for the very services that were keeping him/her alive…. I can’t tell you how many times I heard an insurance’s call center employee tell me (after the therapist had been denied payment), “Okay, I’ll expedite this and send it upstairs. You should have an answer in 45-60 business days.” Seriously, the therapist in good faith provides a life-affirming or life-saving service and not only is initially denied payment, but then it’s “expedited” for another 3-4 months? (And not infrequently, it was denied over and over.)
So now they’re going to use artificial intelligence to decide whether a client needs services that his or her therapist or doctor deems medically necessary… and that artificial “intelligence” has a 90% error rate?
Many health insurance companies, by the way, are publicly traded – which means they are beholden to their shareholders, who apparently are more important to them than the people they are supposed to be helping.
WTH??
Once upon a time, I was against the Affordable Care Act. I believed that competition and a free market economy are good things. And that thought persisted even when I was running an $8.7M company, paying out nearly 10% of that total for health insurance for my employees every year.
However, I’ve reversed my position where health insurance is concerned.
The last time I checked, a “high deductible plan” was $3,000 or more per year – and 51% of all health insurance plans are considered to be high deductible. Also, the last time I checked, 67% of all bankruptcies were because of medical and health expenses.
It doesn’t pay to be complacent about the costs of health care.
I urge you to follow the above links to learn more… and see for yourself the direction our for-profit health insurance industry is headed in.
NOTE: There appears to be an issue with connecting with the links above. Copying and pasting does work, though!
Categories: Business Practices, Health Concerns, Insurance, Medical Debt, Medicare
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