United Healthcare and AI-Driven Denials

[TeleGuy]

Since it's that time of year where we all discuss the pros and cons of original Medicare and supplement plans vs. Medicare Advantage plans in the United States, this article is a reminder of the fact that Medicare Advantage is run by for-profit companies. It's about a class-action suit brought by two families whose insured were denied rehab/nursing home care and how United Healthcare uses AI-based software with a 90% error rate to come up with how much care their patients can get.

arstechnica.com/health/2023...

[Maxone73]

WTF it’s performing worse than a coin toss!

[davidw777 in reply to Maxone73]

I’m sure it’s performing exactly as intended.

[tango65]

Medicare advantage is a capitated system. It may not be accepted by cancer centers which accept regular medicare.

[Hidden in reply to tango65]

There are doctors and facilities that will not accept Medicare due to its denials and lack of payment.

[Tjc1]

I read a similar article. This is what happens when government gets it's hand deep into our medical system. I saw all this coming first when the affordable care act was passed and then when all doctors offices went digital to now AI.

[reichel in reply to Tjc1]

This is not limited to Advantage plans. I read a long article on Cigna using a similar system to deny claims in seconds.

[Shams_Vjean in reply to Tjc1]

Yep, well before ACA the Advantage plans were introduced as a means to privatize Medicare. No surprise to hear how well that’s turned out.

[spencoid2 in reply to Tjc1]

Medicare advantage plans are private for profit not Medicare. Why are you complaining about government when the plans are private. We have had very few denials from our medicare supplement plan and when we do we can usually get our way once we talk to a real person. Do you think that eliminating Medicare would fix this leaving everything to private insurance companies that need to pay their CEO some of the highest rates in business? Where does this money come from? Far worse keeping up these payments than paying for the inefficiency of government which is probably no more than inefficiency in private business.

[ron_bucher in reply to Tjc1]

If you are looking for a boogeyman, it's the private insurance companies, not our government. I dropped my employer's PPO plan and started on Medicare several years before my employment ended, because Medicare plus supplement is a much better deal for people with chronic conditions. Medicare has never even disputed any of my claims, let alone reject them.

My wife was a dentist, and experienced how private insurance companies ruin doctors and patients at the same time.

The US is the only country that has an entire industry dedicated to making profit off of denying health care for its customers. Please stop blaming "government".

[Shamrock46]

My husband is 77 so we've been on Medicare for several years. Our supplement has always been BCBS after I did lots of research. I can't say enough about it because other than the premiums we've NEVER paid for anything out of pocket.....not scans, visits, or any other treatment. And now Medicare is picking up all expenses for palliative care. If you're having problems I suggest you make an appt. at your local office and find out why.

[j-o-h-n]

A I = Assholes Incorporated......

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 11/18/2023 1:30 PM EST