If patients and doctors start using LLMs to strategize how to maximize claim approval rate, I wonder how would the insurance companies react to it. Would it start getting more strict and start requesting for more evidence?
This is already a thing! For example, Neon Health does this for providers. I haven't heard of any changes to the process yet, but I imagine insurers move slower than startups.
I would watch out for insurance as an industry having to increase rates because successful claims rate are increasing much faster than the industry can handle.
Not supporting nor opposing the insurance industry, just something I think the public should watch out for and understand.
Again, this is already happening. Hospital side care providers use systems which optimize for expected payout value. That increases payout totals and insurance costs for everyone.
The ACA tried to make health outcomes a part of the calculation for everyone involved but it is hard to compete with the all mighty dollar.
"Repricers" work on both sides of the equation - providers and provider networks use them to maximize the procedure codes around an ICD-10 diagnosis code.
And insurers use them to minimize the list of procedures they'll accept and pay for around a given ICD-10 code.