Tech Worker Builds Free AI-Powered Tool For Fighting US Health Insurance Denials (sfstandard.com) 52
The online news site San Francisco Standard profiles an open-source platform "that takes advantage of large language models to help users generate health insurance appeals with AI...
"A Fight Health Insurance user can scan their insurance denial, and the system will craft several appeal letters to choose from and modify." With the slogan "Make your health insurance company cry too," [San Francisco tech worker Holden Karau's site] makes filing appeals faster and easier. A recent study found that Affordable Care Act patients appeal only about 0.1% of rejected claims, and she hopes her platform will encourage more people to fight back...
The "dirty secret" of the insurance industry is that most denials can be successfully appealed, according to Dr. Harley Schultz, a patient advocate in the Bay Area. "Very few people know about the process, and even fewer take advantage of it, because it's rather cumbersome, arcane, and confusing, by design," he said. "But if you fight hard enough and long enough, most denials get overturned...."
While some doctors have turned to artificial intelligence themselves to fight claims, Karau's service puts the power in the hands of patients, who likely have more time and motivation to dedicate to their claims. "In an ideal world, we would have a different system, but we don't live in an ideal world, so what I'm shooting for here is incremental progress and making the world suck a little less," she said.
Karau estimates she's spent about $10,000 building the platform, according to the article, which adds that "it's free for users, though she might eventually charge for added services like faxing appeals."
Thanks to Slashdot reader mirro_dude for sharing the news.
"A Fight Health Insurance user can scan their insurance denial, and the system will craft several appeal letters to choose from and modify." With the slogan "Make your health insurance company cry too," [San Francisco tech worker Holden Karau's site] makes filing appeals faster and easier. A recent study found that Affordable Care Act patients appeal only about 0.1% of rejected claims, and she hopes her platform will encourage more people to fight back...
The "dirty secret" of the insurance industry is that most denials can be successfully appealed, according to Dr. Harley Schultz, a patient advocate in the Bay Area. "Very few people know about the process, and even fewer take advantage of it, because it's rather cumbersome, arcane, and confusing, by design," he said. "But if you fight hard enough and long enough, most denials get overturned...."
While some doctors have turned to artificial intelligence themselves to fight claims, Karau's service puts the power in the hands of patients, who likely have more time and motivation to dedicate to their claims. "In an ideal world, we would have a different system, but we don't live in an ideal world, so what I'm shooting for here is incremental progress and making the world suck a little less," she said.
Karau estimates she's spent about $10,000 building the platform, according to the article, which adds that "it's free for users, though she might eventually charge for added services like faxing appeals."
Thanks to Slashdot reader mirro_dude for sharing the news.
Need single payer or more rules about what must be (Score:4, Interesting)
Need single payer or more rules about what must be covered.
Also need an rule saying the parent is not at fault for any billing or coding errors.
Re:Need single payer or more rules about what must (Score:5, Insightful)
That says more about the USA than it does Cuba. You’re telling me I won’t go bankrupt from hospital bills Cuba? How awful.
Re:Need single payer or more rules about what must (Score:5, Insightful)
No need, I already pay close to $900 a month to insure the wife and I. That’s on top of what my employer has to shell out.
The USA generates tremendous economic wealth. Why is it considered bad to use a small fraction of that to improve the health and well being of the citizens of this great country?
Re: Need single payer or more rules about what mus (Score:2)
Re: (Score:1)
Because the US has a genetically diverse population. There's a strong inverse correlation between the genetic diversity of the population and the amount the country is willing to do to help those who are in difficulty.
Re: Need single payer or more rules about what mus (Score:5, Informative)
Australia has a diverse population and we have public free healthcare. It's far from perfect and many people do have private health insurance but at least if you suffer an emergency you can get treated without a massive bill.
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I've heard that many minority groups in Australia suffer greatly without assistance. (Not necessarily in the medical area.) I'm not personally acquainted with Australian conditions, so perhaps this is incorrect.
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It is considered bad because then the rich people would be less rich were they to pay up. And Conservatives would have a great moral dilemma: someone, somewhere, got something for which they had to help pay.
You'd have Conservatives whining incessantly about this. Think of the volume and the hearing damage that would cause.
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Many national health services around the world have reciprocal agreements to provide free healthcare to each others' visitors. Sometimes you have to remember to fill in the appropriate form in advance so that you don't have to go to all
Re: Need single payer or more rules about what mus (Score:2)
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That says more about the USA than it does Cuba. You’re telling me I won’t go bankrupt from hospital bills Cuba? How awful.
You won't get the treatment that you need either. But, at least you won't be bankrupt.
Re:Need single payer or more rules about what must (Score:4, Insightful)
That's a function of the USA, who owns most of the world's pharmaceuticals, refusing to sell them to Cuba, not of Socialism.
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So even a poor nation is able to care for its citizens. Fascinating. Imagine what a rich country could do.
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Cuba is not that primitive. Also, they don't waste a ton on expensive overkill BS like our advanced medicine.
Sure they are way behind... but then in the USA, the most advanced medicine is already out of your reach if you lack the money... So, when it's old and cheap then you can get it free in a poor slower country and still get screwed in the USA. Such as insulin which is old and CHEAP everywhere except in the USA.
Too advanced and it may as well not be considered available yet. At some prices, cheaper to
Re:Need single payer or more rules about what must (Score:5, Informative)
Why limit the option to just Cuba? Because it's communist?
Here’s a list of countries that offer free or highly subsidized healthcare, where not just basic doctor visits but also specialist care and hospitalization are generally covered:
United Kingdom - The National Health Service (NHS) provides comprehensive healthcare, including specialist care and hospitalization, free at the point of use for residents.
Canada - Canada has a publicly funded healthcare system where residents receive free healthcare, including specialist care and hospitalization, though there may be wait times.
Australia - Medicare, the public healthcare system in Australia, covers most healthcare services, including specialist care and hospitalization, for residents and some visitors.
New Zealand - New Zealand offers free or heavily subsidized healthcare, including specialist care and hospitalization, to its residents through a public healthcare system.
Norway - Norway’s public healthcare system provides free or low-cost healthcare services, including specialist care and hospitalization, for all residents.
Sweden - Sweden offers comprehensive healthcare to residents, which includes free or highly subsidized specialist care and hospitalization.
Denmark - Denmark’s healthcare system provides free healthcare services, including specialist care and hospitalization, for all residents.
Finland - Finland offers free or heavily subsidized healthcare, including specialist care and hospitalization, through its public healthcare system.
Germany - While Germany has a mixed system of public and private healthcare, the public system covers specialist care and hospitalization for residents, usually at low or no cost.
France - France provides a universal healthcare system where most costs, including specialist care and hospitalization, are covered by the government, with small co-pays.
Iceland - Iceland offers free or heavily subsidized healthcare, including specialist care and hospitalization, to residents through a public system.
Italy - Italy provides a public healthcare system where most healthcare services, including specialist care and hospitalization, are free or available at low cost to residents.
Spain - Spain has a universal healthcare system that covers specialist care and hospitalization at little to no cost for residents.
Portugal - Portugal offers a public healthcare system where most services, including specialist care and hospitalization, are free or low-cost for residents.
Netherlands - The Netherlands has a universal healthcare system that provides specialist care and hospitalization, usually covered by mandatory health insurance at low or no additional cost.
All of which are democracies that choose to spend tax collected on looking after the population who paid it.
Re: (Score:2)
A week? That's a short wait for me here in US. I can get a phone/video appt in few days but in person it's more then few weeks, unless I am bleeding profoundly all over, then they want me to go to the ER at ~$500 co-pay. It's so great here - all the choices here to make, to live or not to live...
Re: Need single payer or more rules about what mus (Score:2)
Try a different doctor's office? I can get a video visit for free and always same day. Very rarely will it take more than a day for in-person, and usually I can get them next day.
Though if you're on California's shitty medi-cal system, you probably don't have that option.
Re:Need single payer or more rules about what must (Score:4, Informative)
I live in one of those (in EU), where it is free or nearly so.
Though, because of inconvenient queues at the hospital emergencies (for bad flu), or weeks or months of delay to get attention in certain medical specialities, I go to a private clinic, where I have to pay, but I get an appointment for the next day in everything.
My employer has a private insurance, so in principle my co-pay should be very small. Guess what, the insurance refuses. The doc at my clinic says they can help writing letters to get the approval on appeal. Last time after some days I got a reply like a Microsoft errors style "something went wrong, try to submit again". In any case I don't enjoy spending time on playing that game with them, so I just pay whole and they win.
I mean that despite these countries implementing all the best things like single-payer system and free-for-all by principle, insurance denials also exist, even if not a major problem because prices are affordable anyway.
However, I must mention that despite not using much the free public system, I benefit from its existence, because it keeps the prices low in the private. They can only charge a small premium for faster attention.
Re: (Score:2)
So in case of something major, like weeks long hospitalization, operation or so, do you go bankrupt?
Re: Need single payer or more rules about what mus (Score:3)
In 2019 I spent three weeks in the intensive care unit after getting a major infection, followed by weekly in-home visits by a nurse for two months to periodically clean up my access for twice daily IV infusions directly into my heart. Cost me something like $3,200, which was what remained on my $4,000 out of pocket maximum. Paid for all of it with my HSA.
Two years before that I spent three days in the hospital for a kidney transplant, followed by heavy doses of immunosuppressants and about 8 appointments a
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Yup - with good insurance one can survive. Just that not many can afford $2k/month for it. Which it what I'd be paying if I lost my job (via Cobra). The insurance is one side, the cost of health services is another.
I am curious what were the cost of your treatments that was asked and actually covered by insurance?
Re: Need single payer or more rules about what mu (Score:2)
Medicaid, under ahcccs, would have covered the same things in my case.
Re:Need single payer or more rules about what must (Score:4, Informative)
So yea, paying for private health services here would be painful, but wouldn't bankrupt you. In my case I need a hernia operation and went through the public system. They where busy and since my operation was expected to be routine I was sent to a private hospital for the surgery, for free. The first class treatment made all those tax dollars I spent feel worth it.
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If I have a non-urgent problem and I go to the private to have an appointment next day, the consultation is 40 €, with co-pay 15 €. I don't get bankrupt from that. The market value of a medical consultation is zero (since I can get it for free), so they can only charge for the convenience of a less crowded waiting room.
If I have an urgent but not life threatening condition, and went to the emergencies (e.g. a bad wound that needs to be cleaned, a suspicion of broken limb, a very bad flu): at entra
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These costs you've mention are below what I'd pay as my co-payments _with_ insurance. Actually, my copay for a consultation (any visit) is $40 for family doctor and $100 for specialist. CAT, MRI etc scans, if you can get one in few weeks for non-emergency would be around $400 (with insurance). Often the analysis of the test if needed by a specialist is a separate doctors's charge. Yes there is a total out of pocket limit of $4k but co-pays usually do not count against it (it's a mechanism to limit your use
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Imagine: A poor country that has better life-expectancy than the USA and equal child-mortality rates. (Hint: USA rates are not first-world.) The lesson might be, basic healthcare compensates for the problems of the modern lifestyle.
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Tons of free stuff, like poverty. They don't get in those boats and come to the U.S. because they live in "free" paradise.
Repeating something doesn't change much. (Score:2)
We already know that's an obvious fix for this (I agree we should have it). But that's been a non-starter for a while. What else might help that isn't quite that scary?
What about publishing more data? And making that data easy to compare and talk about? Today I can't tell you if a particular company is better or worse than any other. How can we have a free market without knowing who we're dealing with and what they've done before?
Or forcing standardized pricing. Today I don't know how much I'm going t
You don't need an ideal world to improve (Score:4, Insightful)
Awesome! (Score:4, Interesting)
Leveling the playing field in healthcare insurance would likely do wonders to make single payer more politically palpable. Money needs to be taken out of the insurance companies and the end users are more likely to be able to provide the necessary leverage.
Re: One needs only injury care - rest is scam.. (Score:1)
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One word: genetics.
Most applications are denied .. (Score:4, Interesting)
The dirty secret is that most/all applications are denied in the hope the applicant is too ill to go through the appeal process. Or ideally, become deceased by the time the appeal is processed.
Re: Most applications are denied .. (Score:2)
Long ago before joining an HMO that doesnâ(TM)t deny trivial bills, about 40% of my submissions would be denied for no reason I could see. Resubmissions would be approved at about the same rate - no new info provided, just resubmitted. It became a hassle so that I did not resubmit bills for prescriptions or expenses under about $25, which I assume was their intent, to just make things annoyingly tedious so people would give up.
Is anyone keeping track? (Score:2)
Is anyone keeping track of insurance company denials, I mean like who they deny and why. Insurance companies should get famous whenever they weasel out of paying for something.
Re: (Score:1)
Is anyone keeping track of insurance company denials, I mean like who they deny and why.
No, and now that you know, you will proceed to do absolutely nothing about it. But enough of that unpleasantness, how about that local sport team? Looking good this year, amirite? I think we are going to win it all this year!
AI "war" (Score:3)
At least we are one step ahead this time.
What's the problem? (Score:3)
Americans made the decision that health care should be a for-profit undertaking, turning a blind eye to the fact that providing good service is only one of the ways, among many, in which health insurance companies can maximize their profit. It is not even the most profitable one: denying coverage, laying out impenetrable billing, raising premiums, maximizing confusion and complexity, making customer contact cumbersome and inconvenient, etc. are far more profitable strategies.
Americans have exactly what they want, and can't get rid of it even if they were to change their mind: the livelihood of many millions of Americans depends on the system remaining exactly the way it is. Even if they were to decide tomorrow that they want a federal, single-payer system - which they will only when it is a cold day in hell - it would be decades, maybe even generations, before such a thing can be implemented. In the meantime, they will carry on dying prematurely - in comparison with citizens of other developed countries - and becoming bankrupt due to health care expenses.
\o/ (Score:4, Funny)
Wow, AI and Fax in the same article.
This warrants some kind of High Dynamic Range award.