Yeah upcoding itself obviously nothing new

This is so beautiful

Wow suddenly increasing productivity is a bad thing

I’ve seen scattered reports as well of consumers using ai to argue against hospitals coding on bills and generally be their agent arguing with the hospitals about things the Right Way and getting good results, ie paying less money for medical care.

Reminds me of this:

This will end poorly but lmfao that insurance is bitching about having to cover people

The future of hospitals is not great to begin with as basically every other delivery of healthcare is less expensive and gets the same results. Obviously, some parts —ER for serious issues, surgery—can’t replaced, but a lot of stuff can and should be done elsewhere.

Perhaps we should not have sociopaths in charge of Ai after all

The problem is the AI is ahead of us, we already can't stop it, & it's being forced on everything with no serious safeguards. This actually dwarfs Palestine, Iran, midterms, this really is existential. Been on this for months & think I'm losing it realcontextnews.com/the-real…

Is this a stable equilibrium though? Wouldn't we also expect patients and payers to start using AI to arbitrate this kind of behavior from providers? Like, it remains genuinely uncertain where the overall equilibrium will land?

meanwhile I interviewed for jobs with insurers where I would basically be using AI to deny claims so do they want to be the pot or the kettle here

Everyone is aware that medical billing has nothing to do with "costs" and is just a repeated negotiation. Everyone's agents will just fight.

This is such amazing news (for shareholders). This is why investors are clamoring for companies to invest more into AI.

It should be doing the Opposite

It’s called clinical coding and up until now the insurance companies have been getting a free ride because hospitals couldn’t easily find all the appropriate codes to bill for.

OK so 1 providers using AI to drive prices higher 2 when insurance uses AI to fight back they will be evil because, you know, they are doing this for profit

And the insurers also use AI to deny necessary care. It's an arms race out there: AI against AI on both sides. Play ball.

By the same “token”, no pun intended, Blue Cross/Blue Shield should also be using AI to lover costs!!! Their comment is a recognition of ineptitude and a clear “dereliction of duty” of its management.

i'd like to think a second order consequence over the long term is that healthcare costs come down as people all have a preventative medicine application in their pocket.

This is comical. The insurance company association alleges that hospitals gamed the system for more money. What would you expect Blue Cross Blue Shield to say? No independent third-party has confirmed. But we do know @propublica showed insurance uses AI to wrongfully deny care.

Hospitals don’t get paid for “how hard the surgery was.” They get paid for how sick the paperwork says the patient was. Same bowel surgery. Same nurses. Same stay. Then someone adds anemia or diabetes as a secondary diagnosis on the chart, and the insurer’s computer bumps the whole stay into a higher-paying bucket. More money. Often the same care. AI’s contribution is mostly hunting those bump codes, cheaply, overnight, from lab values and notes humans used to miss. BCBS puts most of the extra ~$1B on that secondary-diagnosis trick, not on patients getting sicker. (Their anemia example: more diagnoses, not more transfusions.)

The insurance companies are bloodthirsty profiteers in the value chain. They maximize profits while adding absolutely nothing from a value perspective. They’re a net negative in the process. The providers aren’t “upbilling”. They’re trying to get fair pay for providing a service while a government protected cartel of money managers tries to extract as much as they possibly can in the middle of it.

"When AI Decides If My Patient Gets Their Medication AI driven insurance denials are hurting patients and burning out physicians." psychologytoday.com/us/blog/…

I'm already using AI, as I'm sure others are, to reduce healthcare costs by not needing to go to a doctor or hospital in the first place. Perhaps these two forces will moderate and stabilize or lower prices in the longer term.

Yet more evidence that the part of US healthcare that needs restructuring is the provider level. It's hospital groups, not insurers, that need reigning-in. This will become consensus.

Healthcare providers are the problem with our high healthcare costs, not the insurance companies, and AI only accentuates it.

BCBS isn’t exactly neutral here. Ask them if their reimbursements for primary diagnosis/procedure has kept up with inflation.

"The financial incentives for Medicare Advantage plans to upcode diagnoses are substantial. The reimbursement that Medicare Advantage plans receive for an individual patient from the government is directly related to that patient’s diagnostic codes." nutritionheart.com/medicare-…

It has always been an arms race between health providers trying to figure out how to get paid more and quicker and health payers trying to figure out how to pay less and slower. Cold war with laggards on both side suffering the most.

A health insurance company accusing hospitals of using AI. Isn't that the pot calling the kettle black?

BCBS is probably behind this. Blue Cross Blue Shield plans & other major insurers are vertically integrating with providers like physician practices, clinics, urgent care centers, & pharmacy benefit managers.

Eric Schmidt of Google called this like 4 years ago

Perhaps I am focusing too much on memory and other component parts, but it sure does seem like AI has caused far more inflation rather than the “massive” deflationary effects Elon and others have predicted.

This is strangely worded. If it is legitimate that the AI spotted that the hospital was under billing for the level of care that they were giving, then it makes total sense for them to properly bill for their proper level of care. You and the insurance companies are getting angry that the hospitals are billing for proper levels of care? Cause if they were improper then it would be fraud and thus it wouldn't work. Strange how you got baited into this by an insurance company.