Make money by denying care’: new US rules aim to curb use of approval by private health insurances

The guardian ^ | 02/02/2024 | Jessica Glenza

[tired&retired]

I’ve been fighting Humana for a friend, having now won 5 appeals to keep her in skilled nursing rehab after a severe stroke.

I won an appeal last Saturday and Monday they sent another denied care letter.

Humana joined United Healthcare in using AI software and an algorithm to deny benefits. A class action suit was just filed in Kentucky.

“Lawsuit alleges that Humana used artificial intelligence algorithms to deny key rehabilitation care for seniors. The suit echoes similar allegations against UnitedHealthcare, and the two are the largest players in the Medicare Advantage market.Dec 13, 2023”

https://www.fiercehealthcare.com/payers/class-action-lawsuit-accuses-humana-using-ai-algorithms-restrict-access-care#:~:text=A%20newly%20filed%20lawsuit%20alleges,in%20the%20Medicare%20Advantage%20market.

[tired&retired]

“The company, which is now a subsidiary of UnitedHealth Group’s Optum, has also been at the center of lawsuits against UHC. The nH Predict algorithm projects how long a patient will need rehabilitative services based on “rigid and unrealistic predictions for recovery,” according to the lawsuit.”

[mewzilla]

Likely not for a good reason.

People are refusing to go to their doctors for well care.

Big Med is losing big money.

This is an attempt to get more people to go to the doc.

For why I don't believe it will work, read this reddit thread...

Opinion | My Patients Used to Be Gung-Ho About the Covid Vaccine. What Changed?

Be sure to read the comments, too, if you get a chance.

Trust is the coin of the realm.

And Deep State and Big Med are flat busted.

[caddie]

Big insurance and big medicine is now more a "jobs" program for all the cubicle types in hospitals and in the insurance companies and doctors' offices so that they can play footsie with each other all day on the phone and in meetings. Easily there are 1000% more of these people now than there were in 1990

Thereby employing tens of millions of people under the rubric of "health care" who have absolutely nothing to do with actual care of patients.

It's just bidness. The MBAs smelled the money generated by patient care, and they appropriated most of it, with the help of bribed and/or cowardly physician-"leaders" who were turned by bribes, ushered in the MBAs and gave them the family farm.

The problem is, the people who work in cubicle health care are usually nurses or lazy doctors who went to the dark side.

They are way overpaid for what they do, which is mostly data entry, and of course giving boring and meaningless PowerPoint talks to each other all day in meetings.

We need a bill of rights for physicians and patients so they can exit the system and get paper-and-pen, independent doctors, and freedom.

Oh yeah, and THE TRUTH from their physicians, not propaganda from Big Pharma.

[eyeamok]

The entire health insurance debacle can be fixed overnight by mandating non military Federal Employee’s enroll in Obamacare at their own expense and withdraw all Federal Funds from any State that does not have 100% of their public employee’s enrolled in Obamacare at their own expense.

When they have to live by the same rules, it will be fixed.