Prostate Cancer Claims Denied by an Algorithm

[cesanon]

Can you help me construct a realistic scenario where an Allstate employee would have any incentive to review any of the claims denied by this system? Or where a supervisor would have any incentive to encourage them to do so?

Denied by an Algorithm

Insurance company Allstate has revealed that almost all of the communications its reps send out to claimants are now written by AI, the Wall Street Journal reports.

Allstate chief information officer Zulfi Jeevanjee told the WSJ that AI-generated emails tend to be less accusatory and jargony.

Of course, the tech Allstate is making use of, which is based on OpenAI's GPT large language models, is far from perfect.

"The claim agent still looks at them just to make sure they’re accurate, but they’re not writing them anymore," Jeevanjee told the WSJ.

Despite Jeevanjee's reassurances that human staffers look over the output of an AI for accuracy, we've already seen the tech cause plenty of chaos.

In the medical industry, for instance, "hallucinating" AI models have been shown to still make easily avoidable mistakes.

Health insurance company UnitedHealthcare, whose CEO was gunned down late last year, is also facing a class action lawsuit over its use of AI to often wrongfully deny claims.

In fact, UnitedHealthcare is only one of three insurance companies in the US facing class action lawsuits after algorithms denied potentially lifesaving care.

Competitor Cigna was recently accused of denying more than 300,000 claims in just two months, spending a scant 1.2 seconds on average on each one.

Jeevanjee argues that the tech will allow reps to better understand the needs of customers.

"If I think about the insurance industry in general, we haven’t really done a great job of being customer obsessed," he told the WSJ. "That’s really what I’m trying to drive."

[Kuanyinismybodhi927]

I pay extra to my MO which means that he has individuals on his staff who spend time dealing with claim issues. I recently had a PSMA/PET Scan. I was getting all kinds of nonsense from my healthcare provider over approval of the facility - company doing the scan was "out of network". This was not true since I had had a previous PSMA scan from the same company. Any, my MO's staff kept working on it and notified me when it had been approved. Many companies have ombudsmen who will represent a group member in a dispute. I have had to do this with the dental part of my health plan. However, if you follow developments in the news, you can see that treatment and medication issues will not be improving in the future.

[j-o-h-n]

Health insurance company UnitedHealthcare, whose CEO was gunned down.

Call yours and ask them if their A I software staff ever processed a claim from a Mr. Lock and a Mrs. Load?"

Good Luck, Good Health and Good Humor.

j-o-h-n

[SeosamhM]

No - there is no incentive for a company to review an AI-based insurance decision. Think about it - it's a simple (maybe the "perfect") fix to ignore a real (often desperate) human trying to negotiate a life crisis. Who wants to deal with all of that suffering? Hire some flunky to be George Jetson and push a button and let the machine spew out a mish-mash of written gooblydegook while they stream their favorite shows! All decisions final!

And since we are now in an era where humans have lost critical thinking skills, society simply does not have people available to perform QA/QC on any system, much less an insurance claim where the devil is most likely in the details. Idiot managers, VPs, CEOs, and venture capitalists have completely bought the fairy tale sold by self-proclaimed technocrats that AI is an out-of-the-box solution to the slow, inefficient human worker.

Of course, we here on HU can see through it all. But I have come to believe that we represent an unusual sample of interactive "thinkers" driven and continually trained by our PCa fight.

[j-o-h-n in reply to SeosamhM]

Although I use A I for medical information which is normally over my head, your post hit a bullseye. Thank you!!!

P.S. I think I'll submit your post to A I and see what it says.

Good Luck, Good Health and Good Humor.

j-o-h-n

[SeosamhM in reply to j-o-h-n]

Ha! A+!

[Dont08759]

Rule #1. Appeal every denial! We all know that some health insurance companies are Pirates! Denials are easy, they just send them out! Many patients will not appeal, and they count on your inaction. As soon as the denial appears, it’s time to get your healthcare team in action. Might take a phone call or letter, but keep pressing! In healthcare, you HAVE to be your own ADVOCATE!