“… The “dirty secret” of the insurance industry is that most denials can be successfully appealed…”
Interesting idea, but I imagine it suffers from similar issues to writing legal opinions: by signing your name to it, you’re swearing that it’s all true. Given AI’s propensity for making things up, you need to check everything.
I wouldn’t be surprised if ‘knowingly filing a false appeal’ is a reason to boot you off the plan in the first place.
It’s still a lot easier to review and understand something you weren’t able to write than to also write that same thing without knowing how to write it.
I wouldn’t be surprised if ‘knowingly filing a false appeal’ is a reason to boot you off the plan in the first place.
For that to be an issue you would have to “know” it was false.
You signed it, verifying that you knew what it entailed. That’s what the comment was pointing out.
Usually when signing things off like this, it’s affirming that you believe all statements to be true. They would have to prove you willingly lied, not that you were simply wrong, which is very difficult to prove legally.
That said, IANAL.
What’s the legal code if you THINK something is true and you affirm it, but you are wrong. It can’t be the same as lying since you thought it was true.
I really wonder what the law says on something like that.
by signing your name to it, you’re swearing that it’s all true.
Lawyers too use qualifiers like ‘To the best of our knowledge’ and ‘in our studied opinion’ to indicate that opinions may differ. That’s why judges exist, and some of them are -so reasonable- that they will accept that people cannot be expected to decide whether a hospital’s decision to operate -immediately- is not good enough.
These US ‘insurance’ companies are in the business of making money from people’s health problems. In MOST OF THE CIVILIZED WORLD that’s not how health-care works. We, the people of the US, let the system get rigged this way … we have to fix that. Permanently.
It’s free for users, though she might eventually charge for added services like faxing appeals.
She should sell the home addresses of health insurance executives.
And golf clubs. She should definitely sell golf clubs.
I used to carry what I called a “cracker whacker,” on food deliveries. It was a miniature Louisville Slugger baseball bat. I cut off the last ¼" and used a ⅓" drill bit to create a cavity inside. I then dropped in a 3.5 lb round bar of lead that had about 2" of room on one end to shift back and forth as you swung the bat. I then resealed the bat using the cap I took off, some wood epoxy and 4 finishing nails, just in case.
That thing would easily have shattered a kneecap if I had ever had to actually use it, rather than just brandishing it.
Jesus Christ dude, a Louisville Slugger by itself could shatter a kneecap
Unrelated fact, but on the topic of golf clubs, they are pretty slender. I think they may bend if you hit a large object with them.
Pictured: average Lemmy user.
I wish the average Lemmy user was writing open source tools that help people fight mega corps. That would be amazing!
Same thing but to automatically send emails to your local political representative. Bonus points if I don’t even have to know who it is
Gave it a go. Seems like it has potential. I’m still working through an appeal. My wife ended up in the ER in May and was directly admitted to the hospital for emergency surgery. Ten days afterwards we received a letter from the insurance company saying they had decided it wasn’t medically necessary so they wouldn’t be paying the $67k bill.
It has been a journey trying to get the appeal together. I had hoped the hospital would at least assist with a letter from one of the many physicians that attended her, but nope. We got laughed at by the surgeons office and told condescendingly "Yeah, that’s not how any of this works. "
My biggest concern from the AI generated appeals are being able to confirm the statements it is making isn’t just a LLM hallucination. As a lay person, much of the things necessary to make an argument are paywalled out of reach. For example, the insurance company cited the “2023 InterQual criteria for Surgical Conditions” as the reason why they are denying it. The AI appeal that was generated states that per the 2023 InterQual criteria for surgical conditions that hospitalization was medically necessary.
The only way it seems you can actually get access to InterQual is as a medical provider / payer.
… I thought most people actually just appealed most denials???
I was pretty sure this was already common knowledge?
90% of the time what happens is that you call up your insurance for some shit like hey my jaw be broken as fuck, and they go “nah thats cosmetic” and then you spend 2 weeks fighting with them until they cave and actually cover it.
you call up your insurance
They’re “solving” this problem with less agents or customer service staff, automating the process so you have a robot to deal with that doesn’t ever seem to understand what you’re saying, and can’t get you to the right place. Basically make it as hellish as possible to even get your issue reviewed. Then, they stone wall you and don’t take yes for an answer no matter what
