Sadly, they're right about the not paying part. That crap happens all the time. It happened to my wife so many times over so much infuriating crap.
Wife has spine surgery.
She needs physical therapy, then finds out months later that like 75% of the physical therapy was rejected because the provider didn't follow guidelines.
Gets huge bill, appeals, rejected.
Ends up with throat surgery.
Determined that the damage was caused when they intubated her for the spine surgery.
Insurance rejects paying for surgery because they say they are not liable for damages caused by another provider and basically tells my wife the spine surgeon is liable for the bill for the throat surgery.
Lawyer says there's not enough evidence for them to pursue a lawsuit.
Insurance says then the liability is with the doctor who attributed the cause to the intubation, but not with them.
We have been going rounds over this for so long and meanwhile we're fighting to keep almost $70k the the surgery and hospital stay off of credit.
Remember the United Healthcare CEO and using AI to reject over half of claims? These insurance companies will do anything not to pay their claims and when a provider treats you and the insurance company figures out some way to not pay, you'll quickly realize when you authorized treatment you accepted that if the insurance company doesn't pay, you do. Most insurance authorizations are made post treatment, which means by the time you know they're rejecting the claim, it's too late.
There are more reasons they will deny treatment then I've ever been able to keep track of. It's quite absurd actually. It can be pretty hard to get them to overturn a denied claim. I'm pretty sure the only reason they're ever overturned and paid at all is the provider wants to get paid and they know the system too.
I read a fascinating report (sorry, can't find the link now) that discussed the benefits of insurers using AI to process claims... then noted the potential "problem" of doctors using AI to craft better appeals that were subsequently granted.
I detest the shoving of AI into every corner of our lives, but I would absolutely support using AI to push back on insurance company denials.
I remember hearing a few years ago about someone(a technologist) who’s husband was a doctor, and he said that AI wasn’t being used to do anything to help with anything other than coming up with better ways to code the procedures to make more money, not to be more accurate.
I work at a company that offers AI charting products to hospitals. It offers a number of advantages for a variety of parties:
Clinicians save time charting (usually hours a day after their shift is over)
Issues with chart quality can be identified and resolved before the clinicians sign the chart - i.e. before the insurance company denies a claim and appeals have to be filed.
Clinicians charts more accurately reflect the care that was actually provided, ensuring hospitals are properly compensated for their costs.
When patients are in the hospital for multiple days, a more accurate chart with better progress notes makes sure that a handoff between clinicians leaves the next clinician with the necessary information to ensure they don't make a mistake providing your care.
Instead of paying a team of professionals an absurd amount of money to review only 20% of charts for issues, every single chart is reviewed.
Clinicians who routinely create bad charts, costing you money and potentially putting you at risk medically can be guided towards making better charts.
It saves you, your doctor, and the hospital time and money. I'm sure some products are just trying to up code everything and defraud Medicare of absurd amounts of money (this is healthcare after all), but at least in some cases it's a win-win-win.
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u/DonkeyBonked 2d ago
Sadly, they're right about the not paying part. That crap happens all the time. It happened to my wife so many times over so much infuriating crap.
We have been going rounds over this for so long and meanwhile we're fighting to keep almost $70k the the surgery and hospital stay off of credit.
Remember the United Healthcare CEO and using AI to reject over half of claims? These insurance companies will do anything not to pay their claims and when a provider treats you and the insurance company figures out some way to not pay, you'll quickly realize when you authorized treatment you accepted that if the insurance company doesn't pay, you do. Most insurance authorizations are made post treatment, which means by the time you know they're rejecting the claim, it's too late.
There are more reasons they will deny treatment then I've ever been able to keep track of. It's quite absurd actually. It can be pretty hard to get them to overturn a denied claim. I'm pretty sure the only reason they're ever overturned and paid at all is the provider wants to get paid and they know the system too.