cross-posted from: https://lemmy.blahaj.zone/post/5472838
UnitedHealthcare, the largest health insurance company in the US, is allegedly using a deeply flawed AI algorithm to override doctors’ judgments and wrongfully deny critical health coverage to elderly patients. This has resulted in patients being kicked out of rehabilitation programs and care facilities far too early, forcing them to drain their life savings to obtain needed care that should be covered under their government-funded Medicare Advantage Plan.
It’s so short-sighted and wasteful! A friend of mine got a knee replacement, and then they “couldn’t find” a facility to do her rehab (at their cheap recompense probably) so they sent her home. A few days later she fell and ripped everything apart, necessitating another surgery and even longer rehab. There is no cost savings to be had with this kind of penny pinching. It will no doubt be eaten up by lawsuits.
It honestly feels like the metric has become the target here. By it’s nature, health insurance wants to collect as much in premiums as possible, and pay for as little healthcare as possible. I’ll bet that someone somewhere is assuming that in the long term every claim averages out to roughly equal and is tracking the denial rate instead of the actual amount paid out. If they’re doing that, then your friend’s experience makes sense because they spent more money total but the denial rate was higher than if they had just paid the claim outright.
It’s exacerbated by a labor shortage in healthcare. Rehab spots are hard to find.