General Discussion

AdamGG

(1,525 posts)

34. I worked in a doctor's office, the insurance companies puts up all kinds of crazy hurdles

Thu Dec 5, 2024, 06:50 PM

Dec 5

I worked at a movement disorders clinic (Parkinson's, Tourette's, etc.) at a hospital in Boston. If an expensive drug is prescribed (often levodopa where I was), the insurance companies require the doctor to fax paperwork giving a detailed explanation of why the patient needs it.

Then, the approval is only for 6 months and they will discontinue coverage if they don't get faxed an explanation all over again. These were high level doctors who were very busy - seeing patients one day a week, running research labs, lecturing overseas.

The burden of the paperwork fell entirely on clerical staff, who were already busy and things fell through the cracks. That's what the insurance companies count on, that if they make people repeatedly jump through hurdles, that some of them won't follow up and the company won't have to pay.

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Murdered Insurance CEO Had Deployed an AI to Automatically Deny Benefits for Sick People [View all] Coventina Dec 5 OP

Error rate is a feature, not a bug dalton99a Dec 5 #1

Fortunately, a "90% error rate" does not mean 90% of care was denied. It means that of the 8% or so of claims/authorizat Silent Type Dec 5 #7

Are you saying that all that is okay with you? Am I misunderstanding? niyad Dec 5 #22

No, niyad, I'm saying doctors do cheat. HHS estimates $100 B a year on fraudulent and unneeded care, and that Silent Type Dec 5 #24

At a minimum? Very interesting, given what I have been reading. niyad Dec 6 #80

The fraud has been documented and addressed to some degree. Not as well as it should/could be. Passages Dec 6 #82

There is it Cirsium Dec 5 #25

Well try voter preferences for one. Silent Type Dec 5 #26

Easily resolved Cirsium Dec 5 #32

I agree, but it didn't work under Obama and it's even less likely to work now. If Obama had insisted ACA not use Silent Type Dec 5 #33

Obama did not try Cirsium Dec 5 #35

He didn't once it was obvious it wouldn't pass and might bring the whole ACA down. Silent Type Dec 5 #39

That's the story Cirsium Dec 5 #42

Chamber leaders can count likely votes. We are lucky McCain gave thumbs up for what we got. Silent Type Dec 5 #43

Yep Cirsium Dec 5 #44

Unfortunately, more true now than then. Silent Type Dec 5 #45

How about you? Cirsium Dec 5 #46

We got the best we could get and should be thankful for it and hope that some day in the future it's improved. Silent Type Dec 5 #48

Yes we should be so glad that our betters choie Dec 5 #52

So, how do you plan on pulling this off say in the next decade? Silent Type Dec 5 #53

I don't know, but certainly not sitting in our duffs choie Dec 5 #54

So, you think we can totally reform the healthcare system without leaders and the votes. Good luck. Silent Type Dec 5 #55

Do you realize what you are saying? Cirsium Dec 5 #65

Call up Democrats and get a bunch on board if you think you can, I'll support that. Silent Type Dec 6 #67

You seem almost pleased Cirsium Dec 6 #68

My point is that it's unlikely to happen nowadays, but if you figure out a viable way I will support it. Silent Type Dec 6 #69

I don't believe I said that. choie Dec 5 #66

It has been there Cirsium Dec 5 #61

So Gallop poll that show 53% do not want private insurers, even if under universal healthcare Silent Type Dec 5 #64

OK Cirsium Dec 5 #59

Voter preference elected trump choie Dec 5 #51

The American public has been brainwashed, period lonely bird Dec 6 #79

Like Medicare Advantage which is not Medicare but a privately owned insurance compay.. Historic NY Dec 6 #89

IMO, until Congress decides to provide similar "extra benefits" for original Medicare beneficiaries, we should not Silent Type Dec 6 #90

Why are they shooting the company ex .that sells Medicare Advantage if its so good. Historic NY Dec 6 #94

First off, the shooter looks too young for Medicare. Second, MA is the only potential Silent Type Dec 6 #95

I worked in a doctor's office, the insurance companies puts up all kinds of crazy hurdles AdamGG Dec 5 #34

I'm assuming you also dealt with Medicare coverage policies with crazy hurdles, especially Silent Type Dec 5 #40

I didn't work in billing AdamGG Dec 5 #41

I'm finding this pretty hard to understand MadameButterfly Dec 6 #71

Some. Started out working for a state's Medicaid agency in 1970s and have done similar work since, but not for Silent Type Dec 6 #91

DuRec leftstreet Dec 5 #2

FAFO gay texan Dec 5 #3

Those damn immigrant AIs taking all those jobs from Americans. Jit423 Dec 5 #4

Predatory Capitalism at it's finest, killing Americans. Emile Dec 5 #5

You have to control capitalism Farmer-Rick Dec 6 #78

No tears here either. BannonsLiver Dec 5 #6

I hear ya... I have more sympathy for all the insurees who got screwed, sick, or died under that prick's authority. InAbLuEsTaTe Dec 5 #28

To Borrow from World History Channel on youtube rpannier Dec 5 #8

Worst mistake he ever made. miyazaki Dec 5 #9

The insurance industry is quickly... dchill Dec 5 #10

Why am I not surprised? We need national AI regulation and we need it fucking yesterday. Karasu Dec 5 #11

Every claim denied, was another buck in his pocket. Happy Hoosier Dec 5 #12

Not really true after the ACA EdmondDantes_ Dec 5 #60

All kinds of ways to cook the books Happy Hoosier Dec 5 #62

Is this the start of a French Revolution 2.0? Asking for a friend. NotHardly Dec 5 #13

I certainly hope not. That was a shitshow. Coventina Dec 5 #14

It was indeed a shitshow, but when the alternative is marching quietly into the night for unmitigated fascism... Karasu Dec 5 #18

Blue Cross Blue Shield reversed policy fast womanofthehills Dec 5 #57

It's a hopeless hope. HappyLarge Dec 6 #73

Here's hoping NickB79 Dec 5 #49

Roll out the guillotines!!! moondust Dec 5 #56

This is just BAD johnnyfins Dec 5 #15

has elon delivered his opinion as yet? onethatcares Dec 5 #16

Maybe he got shot by a hologram Prairie Gates Dec 5 #17

We might be at the point where people are so Klarkashton Dec 5 #19

That explains the words written on the bullet that killed him: "deny," "defend" and "depose" Liberty Belle Dec 5 #20

For profit healthcare? theplayer Dec 5 #21

Kansas decided the turn over their Foster Care to a for profit company, a while back... HappyLarge Dec 6 #74

This is alarming and needs some investigation? Merrick? Evolve Dammit Dec 5 #23

If there is a Hell, he's in it. nt SunSeeker Dec 5 #27

Fuckim!! InAbLuEsTaTe Dec 5 #29

So, he didn't even want to pay for quack doctors who couldn't make it practicing medicine to rubber stamp denied on case Attilatheblond Dec 5 #30

Social media is collect gems of responses soldierant Dec 5 #31

BWAHAHAHAHAHAHAHA!!!! AZ8theist Dec 5 #63

Glad you liked it. soldierant Dec 6 #70

I'm not shedding any tears for this evil fatcat slightlv Dec 5 #36

These are sickening denial stats LetMyPeopleVote Dec 5 #37

Two questions about these stats. LAS14 Dec 6 #84

Humana was also found to be using nH Predict... ultralite001 Dec 5 #38

Dude got AI'd right back:Assassinated Intently RedWhiteBlueIsRacist Dec 5 #47

AI is cancer Blue_Tires Dec 5 #50

Only if it's abused, otherwise the potential benefits outweigh the potential cons. cstanleytech Dec 6 #86

I've only ever seen evil and abusive applications of AI Blue_Tires Dec 6 #87

That's probably because AI is still in its infancy and it really has a long way to go before its true AI. cstanleytech Dec 6 #88

That's exactly what worries me 😐 Blue_Tires Dec 6 #92

Don't forget the insider trading probe.. raising2moredems Dec 5 #58

Thanks for pointing out the bogus claim of threats. John1956PA Dec 6 #76

He deserved it. Cne99999 Dec 6 #72

Two years ago, czarjak Dec 6 #75

I cried over John Lennon orangecrush Dec 6 #77

Interesting information. Martin68 Dec 6 #81

Well the 90% error rate was the feature Cthulu on call Dec 6 #83

I wonder if we should start a defense fund 🤔 cstanleytech Dec 6 #85

Well, isn't that swell! City Lights Dec 6 #93