“… 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.
Indeed. Just need to remember that AI can and will hallucinate entire studies or court cases into existence.
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.
I think when you use AI to write the claim and there turn it to be errors even after you checked it, it could still be a case of negligence. Like, not that I think it necessarily should be, but I can see that one could make the argument.
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.
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!
might try that tbh, what’re your ideas?
I’m not sure what you can do. But she wrote a cool tool that generates appeal letters automatically. Just find what is bothering you and work on it.
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
Not fully automatic, but Resistbot may be up your alley: https://resist.bot/
Tag yourself, I’m the dog
I’m calling the oddly placed bosu ball.
Too thin
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
ah yes, this should be illegal, i don’t care how much money it saves.
…This is just a network switch/router.
You sound like one of them fancy book reading types you get the fuck out! Lol
She’s turning into Lain.
Also looks like a few enclosures on a lower shelf (which could be anything) but technically you can run WAN-exposed servers on most routers, not that it’s advised just possible.
We love some good news to start the day
Yeah, honestly the appeal is a standard step in the bottom surgery process in the states. I know one lady who had to explain to her insurer why removal of the penis was a necessary step in her vaginoplasty.
“are you sure it needs to be removed? Have you considered just taking it off first?”
The insurance, probably
“We heard that song. Aren’t they all just detachable?”
detachable penis
You go human
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Maybe take that transphobic take to a community that doesn’t have LGBTQ+ resources as a pinned thread.
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They are saying gender affirming healthcare is often harmful when the medical literature available says the exact opposite. What motivation do you think they have for misrepresenting available medical knowledge?
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“Gender affirming surgery can be the opposite of health care, supporting what neuro-diversity thinks it needs is often harmful to that individual. For example, you wouldn’t prescribe unlimited sleep for someone with narcolepsy.”
… Brushing your teeth can be the opposite of healthcare. sometimes idiots mistake electric toothbrushes for dildos and shove them all the way up their ass.
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Gender affirming surgery is healthcare.
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The idea that trans is “neuro-diversity” is… huh? Do you think gay people as “neurodivergent”?
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Neuro-divergent people often have to advocate for themselves.
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Doctors are educated more about the subject than a random lemming and are more suited to making medical decisions. The research says basically nobody regrets it.
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Surgery is harmful. Sometimes the doctor has to cut you open. But the benefits are often much greater for the patient.
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I’m just JAQin off brooooo, I gotta JAQ offffff, im JAQin offffffff, Im just curious bro, I’m JAQin in my jorts bro, im nearly there bro, I just gotta keep JAQ’in offf brooo I’m nearly there bro you gotta help me finish, au au Im
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Here’s your reminder about gender affirming treatments like testosterone pills and jawline surgery and hair transplants: Elon got all three
And i think he eats bulking powders enough for Arnold, but forgot the training.
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Okay, i happen to actually have narcolepsy & be gender nc, and have a trans partner, i feel like i can speak with some authority on this.
Gender affirming surgery can be the opposite of health care
Every surgery can be, but gender affirming care is one of the least regretted surgeries in existence. By opening this way, you frame the argument as different for trans healthcare. Its not.
We’re also not children. Dont infantilize trans people. We have the same right to make choices others don’t understand, just like cis folks can.
And narcolepsy is a chronic inability to get delta wave sleep. Extra sleep is absolutely treatment. I can see what your getting at, but you’re choosing examples you don’t understand and misinforming people.
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An opinion that ignores all actual research.
Gender affirming surgery helps 99% of people who receive it! So sure, technically, there’s a tiny minority who regret it. More people regret Lasik and boob jobs, should we ban those too? Many people regret a night out drinking, how about we ban that too. Drinking causes way more harm than giving estrogen or testosterone pills to folks.
On the other hand, I like that my friends have the freedom to express themselves any way they want. They aren’t hurting anyone so let’s let them be free to wear whatever clothes they want and take whatever hormones they want.
So join the side of American freedom and let’s stop policing what clothes people wear or what name they use.
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Is prescribing sleep surgery?
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There’s been quite a few reports for this comment, I don’t know if it’s right to remove it, since to me it just comes off as misinformed more than anything and I believe seeing the rebuttals here, coupled with the original comment, is actually more helpful and constructive to the conversation.
Even so, I’ll let the reporters decide if they still wish to hide this comment.I agree with this analysis of the reported comment, and chose to leave it as it has provoked a constructive conversation. It does not appear to be malicious in nature. I will keep an eye on this post to make sure things remain civil. Thank you.
Yeah, though I am still quite unsure, the majority were for removing: 2 that have reached out again, against none other than you who agreed on keeping, factoring in the initial reporters, 5, minus 1 who I count from before, I think I should still remove.
I’m actually past the deadline I gave myself but I want to hear what you think firstI appreciate your thoughts on the matter. I understand that the comment is not based on science and speaks of neurodivergence in a negative manner. By removing the initial comment, I believe it would take away the effectiveness of the commenters below. People vote with the down button and the user can see how unpopular his/her comment is. I don’t wish to overly moderate a community if there is no active harm, especially when others have meaningful sub-comments that can help other casual readers understand the different aspects of what gender affirming care entails, hopefully enlightening others to see it is more than just for trans persons. I respect everyone’s thoughts on the matter, even the ones telling me I am wrong for not removing it. I am still sticking with this decision. Thank you for everyone’s input.
By removing the initial comment, I believe it would take away the effectiveness of the commenters below.
This is demonstrably false, bigots thrive on “just asking questions” which is a well documented trolling tactic, and the replies to their comment will remain even if you remove the bigotry.
I don’t wish to overly moderate a community if there is no active harm,
But there IS active harm - you leaving these transphobic ableist comments up lets neurodiverse trans people like myself know that you prioritise your need for “neutrality” and “meaningful debate” (which is not happening here, you’re just providing more platform for a bigot to spread their bigotry and misinformation) over our safety and inclusion.
I respect everyone’s thoughts on the matter, even the ones telling me I am wrong for not removing it. I am still sticking with this decision. Thank you for everyone’s input.
Obviously you only respect your own opinion then.
Thanks for making it clear that people like me are not welcome or safe in communities you run, I’ll be avoiding them all, as I’m sure others will.
But hey, well done you, you defended a bigot!
I wholeheartedly agree with what you say, I think I’ll leave it be, anyways I’m not against if any other mod steps in to delete, I’m just sorry that I have to go back on my word of being merely a collector of votes, in the end I really do think this is a useful record to keep and it wouldn’t be in me to take action against it by erasing, because I think the better action against it is to let others to see for themselves and learn by seeing how the wrong stance is disproved
As someone with IH/N2 (idiopathic hypersomnia/narcolepsy type 2) extra sleep doesn’t do shit.
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