Posted on 11/19/2023 7:37:12 PM PST by anthropocene_x
Although artificial intelligence is in its early stages in the health-care industry, it already has triggered legal action. A class-action lawsuit filed on Tuesday alleges that UnitedHealthcare used an artificial intelligence algorithm to wrongfully deny coverage under Medicare Advantage health policies.
The insurer made health-care determinations using its nH Predict algorithm, overrode physician recommendations, and denied elderly patients’ claims for stays in extended-care facilities, according to the lawsuit in the U.S. District Court for the District of Minnesota. The plaintiffs also alleged the technology lets the company “aggressively deny coverage, because they know they will not be held accountable for wrongful denials.”
When these coverage denials are appealed to federal administrative law judges, about 90% are reversed, demonstrating the “blatant inaccuracy” of the nH Predict algorithm and attesting to the AI’s ”90% error rate,” the complaint said.
UnitedHealthcare was “effectively using AI to throw the elderly — our parents or grandparents — out onto the street,” said Ryan Clarkson, managing partner of Clarkson Law Firm. “Defendants bank on the patients’ impaired conditions, lack of knowledge and lack of resources to appeal the erroneous AI-powered decisions,” the complaint said.
(Excerpt) Read more at benefitspro.com ...
UnitedHealth has been a major "donor" to legislators friendly to them from both wings of the Uniparty.
ping
UNH stock price is $536.29 per share, up 102% in the past five years.
They are scum!
And you think that Skynet was fiction?
The best defense against United Healthcare is .... stay healthy with regular exercise. It is working for me!
Perhaps this is one reason for my large medical group canceling their UnitedHealthcare Medicare Advantage contract.
Wrongfully???
It’s the plan.
Is Pfizer still rising?
LOL.
Cigna is being sued for the same thing, and it’s true, they have refused my simple claim that is explicitly approved. The claims people jeep saying it is covered and sending it back through, and it’s refused again.
Anthem BCBS is another health insurer which plays dirty tricks to avoid payments. However, United Healthcare is the worst of the dirty lot.
Here’s how insurance companies make money:
1) Collect ever increasing premiums
2) Deny as many claims as possible
3) Slough potentially costly customers
The one that stuck out was a man had both legs amputated. His doctor prescribed a wheelchair as medical equipment. It was denied because she had not tried physical therapy first. I was unaware that physical therapy could cause legs to regrow. Truly we live in a age of marvels.
Actually the last part is true. We do live in an age of medical marvels. But we also live in a age where you may be taking something for years and suddenly your doctor has to fill out a bunch of forms about why you still "need" it. While the process is happening you will be denied your blood thinner, heart medicine, thyroid medicine or other such items while a collection of bureaucrat with no medical training decide if you actually "need" it.
Stay OUT of Medicare Advantage plans.
Whatever system they devise, health insurers should be liable for a pattern of wrongful denials. They chose either AI or subcontractors, and they should not be able to avoid personal liability. I would like to see a case that holds otherwise.
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They push these plans so hard because they benefit the insurers and not the patients. You should never choose one of these plans.
AI always was about killing homo sapiens.
Some folks just didn’t get the memo yet.
Sounds like something the $hot $hill$ would try.
Because SCIENCE™!
Insurance companies have always made their money by not paying claims. This is nothing new.
My wife and I have had a Medicare Advantage plan (United Health Care) for 10 years and they have covered everything.
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