I was in medical billing about 20 years ago, specifically working to get ambulance billing paid by United Healthcare, Blue Cross, whatever. at that time I hated united slightly more than the VA. the VA was a year behind on payment, and they sent a lump check with the list of what it covered separate. but at least they kept track and paid.
we had to take United Healthcare to the insurance commissioner because their process was deny, then lose the claim, then deny for late billing.
instead of responding to the insurance commissioner or providing the requested docs or anything, they waited it out, paid the fine, paid the specific claims, and continued as usual.
Guessing that’s not an error rate, just programmed to refuse first attempts to save cash
I was in medical billing about 20 years ago, specifically working to get ambulance billing paid by United Healthcare, Blue Cross, whatever. at that time I hated united slightly more than the VA. the VA was a year behind on payment, and they sent a lump check with the list of what it covered separate. but at least they kept track and paid.
we had to take United Healthcare to the insurance commissioner because their process was deny, then lose the claim, then deny for late billing.
instead of responding to the insurance commissioner or providing the requested docs or anything, they waited it out, paid the fine, paid the specific claims, and continued as usual.
so yeah. AI working the way they trained it.
Nonsense.
It’s most likely just a ~linear regression~ random forest model trained with the loss function of
sum((y - y_hat)^2 * cost)I have that basic prediction tools are “AI” And they definitely were in 2019.
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