[siliconc0w]

AI adjudication of healthcare is fine but there needs to be extremely steep consequences for false negatives and a truly independent board of medical experts to appeal to. If a large panel agrees the denial was wrong, a penalty of 10-100x the cost of procedure would be assessed depending on the consequence of the denial.

[vkou]

Or, and here's the wild thing, put all these parasites, leeches, and other useless middle-men out of a job and just go single-payer.

[throw10920]

Yes, I agree. My point was contingent on the current state of affairs - until we can change that, then AI remains a terrible idea.

[reassess_blind]

No one is going to accept a claim rejection from AI. Everyone will want to dispute, which will have to go to a human to review. At the end of the day I don’t see how 100 people is realistic.

[bcyn]

This reaction is primarily an emotional one. Why is a human rejecting a claim better than an AI rejecting a claim? Presumably the AI will one day -- if not today -- be more accurate in following decisioning logic than humans, who will continue to make human errors.

[potato3732842]

The AI won't reject a claim because that's easier than doing the paperwork to approve the claim and it's 4:30 on a Friday.

It also won't approve it because despite not putting the "magic words" on the form it's clear from the situation that you'll get approved regardless and it's a waste of the company's labor to have you file an appeal that they then have to review.

I'm not sure which case is more common though.

[aianus]

If that were true then they would also dispute every first-line human review. I don't think the average first-line human customer service rep is any better than AI even today.

[mring33621]

Fine! You win!

We'll send the appeals through Mechanical Turk.

Happy now?