For Profit 'Medicare Advantage' Plans Using AI, Artificial Intelligence for Denials - 'Not A Doctor'

[appalachiablue]

- 'This Should Be a National Scandal': For-Profit Medicare Advantage Plans Using AI for Denials,' Common Dreams, Nov. 3, 2023. - "They're using AI to predict when to cut off payment for treatments," said one watchdog group. "AI. Not a doctor." - Edited

As Medicare Advantage plans rely increasingly upon artificial intelligence to determine—and often deny—payment for patient care, a group of Democratic U.S. lawmakers on Friday urged Medicare's top official to strengthen oversight of AI and algorithmic tools used to make coverage determinations.

"In recent years, problems posed by prior authorization have been exacerbated by MA plans' increasing use of AI or algorithmic software to assist in their coverage determinations in certain care settings, including inpatient hospitals, skilled nursing facilities, and home health," 32 House Democrats wrote in a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Books LaSure.

"Advocates and the media report that the use of such software has led to coverage decisions that are more restrictive than allowed under traditional Medicare rules, as well as more frequent and repeated denials of care," lawmakers wrote. They are calling on CMS to take steps including, but not limited to: Requiring MA plans to report prior authorization data including reason for denial; Comparing "guidance" generated by AI with actual MA coverage decisions..

MA plans are not part of Medicare. They are a private health insurance "scam" created by a GOP - controlled Congress and signed into law 20 years ago by Pres. George W. Bush. The letter is endorsed by advocacy groups. "The use of AI by Medicare Advantage insurers to deny needed care to seniors and people with disabilities represents the most recent and dangerous step by greedy companies focused on profit instead of patients," Public Citizen Exec. VP Lisa Gilbert said...
https://www.commondreams.org/news/medicare-advantage-2666143830

[bucolic_frolic]

1. MA Plans and Payments are a giant transfer of wealth UP the income scale

The objective is to eventually as the insured age pay fewer and lower claims and saddle families with copayments and hospital bills.

Follow the money.

[appalachiablue]

2. Check, another deceptive plan to enhance Trickle Up

It's always about the bucks

[Silent Type]

3. Unfortunately, traditional Medicare still has coinsurance and deductibles after almost 60 years.

Only way to avoid them is to buy expensive MediGap policies from private insurers, qualify for Medicaid by being poor, or pay it yourself.

[appalachiablue]

4. Such a ripoff, they think of every angle

[bucolic_frolic]

5. Is the choice of Medigap or MA required? Can one choose traditional only? /nt

[Silent Type]

6. Not mandatory. But, you gonna pay 20% of a heart surgery, brain surgery, chemotherapy, knee surgery, etc.?

Not mandatory, but you better be wealthy, and that knocks your monthly premium taken out of Social Security to almost $600 a month.

[anciano]

7. No, not mandatory.

You can choose to only have Original parts A and B, but will have to pay deductibles and co-pays out of pocket, and also any prescription drug expense.
One other very important note, if you don't get a Medigap policy during your guaranteed issue period you may be denied coverage if you later decide you want to add one. However, you can still change to an advantage plan later during the annual enrollment period if you decide to do so.