Fuck AI

I do see your point but the reality is that improving the flawed healthcare system through supercharged billing is like fixing your car with extra hard praying

I work in this space. I agree with the gist of what you’re getting at; the catch is that it’s mostly just feeding the beast rather than breaking the dynamic.

With LLMs, the problem is that they’re neither objective nor consistent, so the insurance companies are just going to increase their headcounts and hire more people to contest submitted claims. Deterministic output would change the picture in a big way, but I’m not seeing much appetite for that in the market for some reason.

There’s a lot more potential for disruption in the form of advanced monitoring that can automatically flag and document complications in an objective way (which is my professional wheelhouse, for the sake of disclosure), but even then I expect payors to mostly pass the increased reimbursement rates on to their enrollees.

A single-payor model is the biggest real cure for what ails our system, and I think I speak for a lot of us in the industry when I say that we’d happily lose our jobs to see that happen for the greater good.

If you kept reading you would see:

However, the BCBSA warns that if patients really were becoming sicker, we should be seeing increases in treatment – but we're not. "The disconnect between diagnoses and treatment suggests that AI is identifying more billable conditions, not sicker patients," SVP of Product and Data Science Luke Chalker said.

Who cares if it says it’s identifying more, the real indicator is healthier patients or increase in care, neither is happening.

Fun fact: Nope.

Ever get a little check back from your insurance company claiming they want to pass back the savings, or some bullshit like that? It's a lie. Insurance companies are legally required to pay out 85% of everything they collect back out to the insured. If you ever get one of those little checks, it's because they didn't pay out enough for the year and have to send money back out to get down to the 85%.

Insurance companies want prices to go up on everything. It means they can just charge more for insurance and their 15% chunk they get to keep is a bigger number.

What they don't want is things that are hard to be consistent with or high temporary costs for a small amount of people. It makes it harder to just barely hit that 85% payback for the year and could set a precedent for something they approve. They want 500 people paying $2,000 a piece for a broken limb through insurance every year. It's common, it tracks about the same every year, and it means they can count on it being fairly close to the same costs every year and makes it easy to factor in when telling everyone how much insurance will cost them for the year. $1,000,000 paid out, meaning they'll count on making around $150,000.

What they don't want is one patient needing $1,000,000 worth of cancer treatment. They can't plan for those as easily and there's a higher risk you could need something similar in the future again if you relapse. They'd rather you be dead.

So the short explanation is "no". There will just be a bit more adjusting and the insurance companies will be right back to getting their blood money maximized again.

The one thing it seems to be okay at is parsing text that’s devoid of emotion. If you just need it to find and point out loopholes and lapses in judgement, it can do that. Just don’t expect it to be able to produce something coherent on its own in the same context.