| "Using it to". Problematic phrasing. I'm sure they also use paperwork to deny claims. Would you make that into a headline? It's like "using dice to deny claims". Yeah... I guess? But they are the ones performing the actions. What they base those actions on is besides the point. The point is that denying claims, particularly denying >90% of claims as the first generation of "AI" did (a D20 model), or denying claims requested by doctors without a Very Good Reason, is tantamount to refusing medical treatment to people who have already paid to be covered for medical treatment, and may stand to die if their medical conditions are not treated, as a result of second-guessing the doctor. It also dramatically reduces the productivity of doctors, who are being filibustered by a system that forces ever-increasing amounts of pre-approvals, charting requirements and appeals on them. If the median doctor can suddenly only perform half as much work... people also die as a result. It's not behavior that _deserves social protection_, is the point. Allowing companies to participate in social murder & fraud if they claim an AI told them to internally is morally, politically, bureaucratically, and economically abhorrent. Tear it all down and salt the earth with the bankrupt remains of these companies that had the _audacity_ to shift to second-guessing a majority of medical claims. > Before health insurers reject claims for medical reasons, company doctors must review them, according to insurance laws and regulations in many states. Medical directors are expected to examine patient records, review coverage policies and use their expertise to decide whether to approve or deny claims, regulators said. This process helps avoid unfair denials. > But the Cigna review system that blocked van Terheyden’s claim bypasses those steps. Medical directors do not see any patient records or put their medical judgment to use, said former company employees familiar with the system. Instead, a computer does the work. A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity. > “We literally click and submit,” one former Cigna doctor said. “It takes all of 10 seconds to do 50 at a time.” The problem is not the dice. It's the denials. RealPage is a service used by landlords to fix prices and reduce competition. It doesn't actually matter that it uses AI to achieve this, they may as well have used in person conversations or a weekly newsletter, what matters is that it's all price collusion. They aren't "using AI to...", they are knowingly and proudly fixing prices to reduce price competition, and AI (or some kind of algorithm at least) may be used somewhere in the data analysis tools. |
Though they aren't claiming that it's okay because AI does it. It's that it's profitable and makes it even more so because now they can fire the people whose jobs it was to deny claims.
You can get away with most things in business so long as a pension or retirement fund gets to wet its beak. And that's what private insurance with no public alternative does.