TheBiggestJerk
Well-known member
Sweet. We need more dead CEO’s. Maybe they can work a few bank and big pharma CEO’s into the spree.
rsm
Well-known member
The bureaucracy in insurance and providers is overwhelming. The article in the OP reminded me...this is going back to the late '80s - early '90s...
Back in the dark ages of AI, I co-designed an AI system for health care claims processing for a large insurance company; shortly after that I designed and programmed a neural network (AI) system to detect fraudulent claims at another insurance company; and at the second company, I designed and programmed another AI system to look at the procedure codes in claims to determine if they were correct, accurate and if they used "bundling/unbundling" - which would change the fees and reimbursement for the procedure....for example, a procedure could have multiple codes that would be used in different situations, such as planned surgery vs emergency surgery...for the same procedure, would have different codes...
On the provider side, there were AI systems that would help them bundle/unbundle procedure codes on the insurance claim to maximize what they were paid.
It was an arms race. From the AI systems I created for the insurance company, we could identify claims that had a probability of being fraudulent; and we could assess the procedure codes to see if they were correct, there were many others that I forget...but the goal was to deny claims or reduce the amount paid for claims, and do it within the contract terms and the applicable laws.
just sayin'
Back in the dark ages of AI, I co-designed an AI system for health care claims processing for a large insurance company; shortly after that I designed and programmed a neural network (AI) system to detect fraudulent claims at another insurance company; and at the second company, I designed and programmed another AI system to look at the procedure codes in claims to determine if they were correct, accurate and if they used "bundling/unbundling" - which would change the fees and reimbursement for the procedure....for example, a procedure could have multiple codes that would be used in different situations, such as planned surgery vs emergency surgery...for the same procedure, would have different codes...
On the provider side, there were AI systems that would help them bundle/unbundle procedure codes on the insurance claim to maximize what they were paid.
It was an arms race. From the AI systems I created for the insurance company, we could identify claims that had a probability of being fraudulent; and we could assess the procedure codes to see if they were correct, there were many others that I forget...but the goal was to deny claims or reduce the amount paid for claims, and do it within the contract terms and the applicable laws.
just sayin'
TheBiggestJerk
Well-known member
Something I read.
“I’m in pharmacy. I’ve been in pharmacy for nearly ten years. I’ve seen grown adults cry and beg for alternatives because their insurance denied it. I’ve seen pharmacists make us leave the room so they could buy a patients insulin and give it to them because they were out of government assistance “the doughnut hole” it was called.
I’ve watched as a patient turned from happy to be progressing through their day to devastated because their insurance refused to cover a medication that their doctor ordered.
Insurance companies are on par with arms dealers and sex traffickers in my mind. They arbitrarily put people in physical, emotional, and financial, hell by applying different rules however they want. They have little to no oversight, and they rape the American populace to the tune of tens of billions ($317 billion this year for United) and I’m supposed to feel bad for the man who leads the charge on cost cutting by butchering the lives of average Americans? How can I shed tears for a man who physically embodied the most ravenous perpetuation of greed and selfish skullduggery in American history.
His family is likely lost and hurt, I feel bad for them. But I hope they realize that the life they lived was from the gleeful rejection of care for the most needy. Their life was built on the backs of sick and dying Americans.”
“I’m in pharmacy. I’ve been in pharmacy for nearly ten years. I’ve seen grown adults cry and beg for alternatives because their insurance denied it. I’ve seen pharmacists make us leave the room so they could buy a patients insulin and give it to them because they were out of government assistance “the doughnut hole” it was called.
I’ve watched as a patient turned from happy to be progressing through their day to devastated because their insurance refused to cover a medication that their doctor ordered.
Insurance companies are on par with arms dealers and sex traffickers in my mind. They arbitrarily put people in physical, emotional, and financial, hell by applying different rules however they want. They have little to no oversight, and they rape the American populace to the tune of tens of billions ($317 billion this year for United) and I’m supposed to feel bad for the man who leads the charge on cost cutting by butchering the lives of average Americans? How can I shed tears for a man who physically embodied the most ravenous perpetuation of greed and selfish skullduggery in American history.
His family is likely lost and hurt, I feel bad for them. But I hope they realize that the life they lived was from the gleeful rejection of care for the most needy. Their life was built on the backs of sick and dying Americans.”
G
Geo
Well-known member
I am surprised it doesn't happen more often.
Also, all the hospitals that killed people with Remdesivir, how do they skate?
Also, all the hospitals that killed people with Remdesivir, how do they skate?
JackBootedThug
MURDERATOR
Robber baron financial fucks need some also. Let’s not stop there there though…maybe it will start a trend on tik tok… merc the godless ceo who only cares about profits. Include some other ones that I won’t mention but you can figure out what I mean. Let’s bring some integrity back to the system….
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