Reply to US healthcare blows: investigation reveals major insurer was using an algorithm to determine amount of care for patients

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[quote=Anonymous][quote=Anonymous]Ahhhh, good ol US healthcare is the best, right?

https://www.statnews.com/2023/07/11/medicare-advantage-algorithm-navihealth-unitedhealth-insurance-coverage/

Not sure if you have access through your library, but the gist of the story is that NaviHealth, which is now owned by UnitedHealth, was mindlessly using computer algorithms to determine how much care patients deserved.  This often led to rejection of coverage despite patients still being seriously ill and requiring intensive care according to first hand reports from clinicians actually treating the patients.  NaviHealth management would routinely question and slap down any case file reviewers who thought additional care should be provided based on updated case reports if it conflicted with discharge dates predicted by the computer algorithm they used to model care and expected patient recovery.   In one case, a guy was sent home only half way through his rehab after major brain surgery....he complained days later about pain and ended up dying from meningitis.  Similar other horror stories in the article.

What a dystopian nightmare the US is becoming.  Computers will now override all clinical judgement for healthcare. If you don't recover by the time that's needed that AI predicts is needed and that will also maximize profits for insurers you can say good bye to your coverage for a procedure and recovery.

It's like the US goes out of its way to be a 3rd world country in terms of healthcare. [/quote]

OP, a corporate bottom line and value for the shareholders is far more important than people’s lives.[/quote]

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