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UnitedHealthcare used AI that denies 90% of claims

!codecels

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UnitedHealthcare used AI determinations technically reviewed by humans that denies 90% of claims

"Optum Health told Ars Technica: "The NaviHealth predict tool is not used to make coverage determinations. The tool is used as a guide to help us inform providers, families, and other caregivers about what sort of assistance and care the patient may need both in the facility and after returning home. Coverage decisions are based on CMS coverage criteria and the terms of the member's plan. This lawsuit has no merit, and we will defend ourselves vigorously."

This is actually correct lol, they have no case. NOT using AI here would actually be so grossly negligent to your average tax payer and it would be a massive scandal worthy to sue the government for utterly wasteful spending when all the computer does is spit out a nice summary of why or why not the legally established guidelines for care coverage are met or not met.

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Somewhat surprised Ars would have that poor of an article.


Follower of Christ :marseyandjesus: Tech lover, IT Admin, heckin pupper lover and occasionally troll. I hold back feelings or opinions, right or wrong because I dislike conflict.

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They should just stick to vidya game dev interviews :derpwhy:

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I thought the same thing. “90% error rate” because 90% of claims appealed are overturned… what is selection bias


:#marseyastronaut:

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  • case file lands on me dashboard

  • AI made a judgment

  • Click "verify judgment"

  • Go back to playin solitaire

  • simple as

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Damit do you even know how much money these bad boys cost or the effort it takes to trigger them confirm a denial?

https://i.rdrama.net/images/17007078682133079.webp

:marseyindignant:

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  • appeal comes in

  • click "deny appeal"

  • cash paycheck

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eVErY CaSe is rEViewWd bY a HumAn

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>if client.condition=obesity;

>deny client.claim

:gigachad2:

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Lol I had a boss from the Philippians who had a brother still there whom had a gas tank of a motorbike explode in his face when trying to work on it and was brought to their local ER with life-threatening burns and injuries. According to her their process is

>if client.condition=money.up.frount

>then:admit.treat

>else:contact.relative

>loop until:money.up.front

>else.relative=0: patient.dies.on.floor

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Yup, same thing in China. A lot of Asian countries do not value human life at all

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a pluralistic society if you will

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It says 90% error rate.

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