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Публикация

Boston Tom Levenson

Prison time would seem to be appropriate for every executive in the decision tree.

ProPublica

Internal documents and former company executives reveal how Cigna doctors rejected patients’ claims without opening their files. “We literally click and submit,” one former company doctor said. (Published March 2023 w/ @capitolforum.bsky.social)

Обсуждение

1 прямых ответов · 2 сообщений

PlottingFuture

Sadly this story is 3 years old and nothing has changed for the better. AI algorithms steering claims to automatically approved versus "needs checking" technically do not deny a claim but these systems reward clinicians based on throughput.

Ответ для PlottingFuture
PlottingFuture

The only way the AI pays for itself is if humans go faster, performing less diligence on their checks. Also look at Navi-Health (owned by UHG), decision making for rehab stays. The managers there pressured staff who overturned incorrect AI recommendations. Not all failures are AI, but system fails.