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Feds Have Warned Medicare Insurers That ‘AI’ Can’t Be Used To (Incompetently And Cruelly) Deny Patient Care (www.techdirt.com)

submitted 7 months ago by [email protected] to c/[email protected]

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[–] [email protected] 3 points 7 months ago* (last edited 7 months ago) (1 children)

Who needs "AI" when the simple algorithm they already use works perfectly well?

while 1==1:
    deny_coverage = True

[–] [email protected] 2 points 7 months ago

I hate that you are absolutely right.

Medical directors do not see any patient records or put their medical judgment to use, said former company employees familiar with the system. Instead, a computer does the work. A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity.

“We literally click and submit,” one former Cigna doctor said. “It takes all of 10 seconds to do 50 at a time.”