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14 replies

pelespirit
sh.itjust.works

Wow, this is a whole lot of double speak.

UnitedHealthcare, which has not commented publicly on Levy's post, said in a press release on its website December 13: "UnitedHealthcare approves and pays about 90 percent of medical claims upon submission. Importantly, of those that require further review, around one-half of one percent are due to medical or clinical reasons. Highly inaccurate and grossly misleading information has been circulated about our company's treatment of insurance claims."

This is from 2023:

In their complaint, however, the families accuse UnitedHealth of using faulty AI to deny claims as part of a financial scheme to collect premiums without having to pay for coverage for elderly beneficiaries it believes lack the knowledge and resources "to appeal the erroneous AI-powered decisions."

UnitedHealth continues "to systemically deny claims using their flawed AI model because they know that only a tiny minority of policyholders (roughly 0.2%)1 will appeal denied claims, and the vast majority will either pay out-of-pocket costs or forgo the remainder of their prescribed post-acute care."

Source

52
TipRingreply
lemmy.world

The "90% of medical claims" is such a weaselly metric. Yeah, if you have a small-cost claim like your annual physical or basic x-rays they pay, but if you need anything that costs money, that would push you over your deductible, they deny. Saying 90% just isn't meaningful if most claims are small-dollar.

56
Websterreply
lemmy.world

Claim is also a later step in the process. The first step is prior authorization. So they could deny the prior auth that leads to work not being done which leads to no claim to count as a denial. Or a patient doesn't submit the claim because it had a denied prior auth, so again no denied claim. 90% on claims is a terrible percentage.

31
lemmyngreply
lemmy.ca

I wouldn't be surprised if they also carefully selected the "medical" part. Drug prescription? Medical. Post-intervention recovery? Not "medical".

18
RustyShacklefordreply
literature.cafe

What reporting is there left? It’s not like news media can really be taken seriously anymore.

Most companies would rather believe they can use AI to solve everything, leading to less workers equaling higher profit margins. Which will be an even bigger belly flop.

21
halcyoncmdrreply
lemmy.world

This isn't HIPAA. Talking about patients, procedures, insurance issues, etc. without identifying information doesn't violate HIPAA. The original post from the doctor didn't have patient information.

Most likely this is UHC telling him to remove it or they'd blacklist him and any medical group he works for/with. An individual doctor is easy to threaten. And just adds more proof to what we already know about the "Walmart of healthcare" that is UHC.

34
Sludgehammerreply
lemmy.world

Wow... registered today, banned today, -27 votes on his only post. Kinda glad I missed it.

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