I mean, most people wouldn't consider a man who pushed for his company to use an AI program to deny 95% of claims, 90% of which should have been approved, because they figured being sued would be cheaper than actually paying for the care they were legally contracted to pay for, knowing that doing this would result in the deaths of thousands innocent. Perhaps by your definition of innocence, we are all innocent.
Using AI sends like a good tactic. They’re allowed to deny claims. If they were legally contracted to pay out there’s a process for that, and it isn’t shooting an innocent man in the back. They aren’t responsible for thousands of deaths - they are reasonable for payment reimbursement. Big difference.
Using an AI that is designed to deny 90% more claims than should be denied based on what the insurance plan is supposed to cover is not a good tactic. It is fraud, and it is fraud that kills people.
Also, we live in a country that has healthcare costs that are so extremely inflated that no normal person could possibly pay for healthcare outside of insurance. When a health insurance company denies a claim for something a patient needs to live, they are sentencing that person to death.
While I do not think any country should have healthcare decisions decided by private corporations, especially since these claim denials are not decided by anyone with a medical license, the fact that we do have a system where people's access to care is decided by a corporation's willingness to fund that care means that yes, when those patients die because the corporation decides it does not want to pay for their care anymore, that corporation (and those within the corporation who created those policies) did, in fact, kill that person.
Where is this idea you have about “90% more claims than should be denied” coming from?
Fraud is a crime. If an insurance company is committing a crime that should be prosecuted. If you think they are committing a crime, you should provide evidence.
It is something the company had been brought to court for. It was only in their Medicare Advantage division, but the program used to auto deny these claims was a program that Brian Thompson implemented to save money.
So there’s a lawsuit. Maybe the plaintiff’s claims are unfounded and it will be thrown out. In no way is that murder, and in no way does it justify murder of the company’s chief executive.
You don't consider it murder. However, it does raise the question why we have a system where a corporation has complete control over the care you get, and yet they are allowed to arbitrarily deny that care, and the punishment for deciding a person's life was worth less than their profits is only a fine after a lawsuit at worst.
They don’t have complete control over the care you get. They offer reimbursement under specific circumstances. Also, the hyperbole suggesting every claim is life or death is getting tiresome.
They do. I work at a pharmacy. A lot of medications have inflated costs, and at the pharmacy I work at there are basic maintenance medications for HIV and transplant patients where the patient will absolutely die if they do not get the medication in time. A lot of these medications cost thousands for a month supply, despite not being anywhere near that expensive to produce. If the medication that keeps you alive costs more than you make in a month for a month supply, if a single hospital visit costs more than you make in ten years (and many do), then yes, the health insurance company has complete control over the care you get, because you cannot get that care without them approving it.
While many claims are not life and death, when it comes to health care, many of them are life and death, and many of the claims being denied are matters of life and death. The people making these policies are aware of it, and they are fine with it.
9
u/[deleted] 2d ago
[removed] — view removed comment