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Interesting idea, but I imagine it suffers from similar issues to writing legal opinions: by signing your name to it, you're swearing that it's all true. Given AI's propensity for making things up, you need to check everything.
I wouldn't be surprised if 'knowingly filing a false appeal' is a reason to boot you off the plan in the first place.
It's still a lot easier to review and understand something you weren't able to write than to also write that same thing without knowing how to write it.
I wouldn’t be surprised if ‘knowingly filing a false appeal’ is a reason to boot you off the plan in the first place.
For that to be an issue you would have to "know" it was false.
You signed it, verifying that you knew what it entailed. That's what the comment was pointing out.
Usually when signing things off like this, it's affirming that you believe all statements to be true. They would have to prove you willingly lied, not that you were simply wrong, which is very difficult to prove legally.
That said, IANAL.
What's the legal code if you THINK something is true and you affirm it, but you are wrong. It can't be the same as lying since you thought it was true.
I really wonder what the law says on something like that.
It’s free for users, though she might eventually charge for added services like faxing appeals.
She should sell the home addresses of health insurance executives.
And golf clubs. She should definitely sell golf clubs.
Unrelated fact, but on the topic of golf clubs, they are pretty slender. I think they may bend if you hit a large object with them.
That's why Casey Jones traded the golf club for a hockey stick in the first movie. At which point he opened a can of whoop ass all over the foot clan thugs.
Pictured: average Lemmy user.
I wish the average Lemmy user was writing open source tools that help people fight mega corps. That would be amazing!
might try that tbh, what're your ideas?
I’m not sure what you can do. But she wrote a cool tool that generates appeal letters automatically. Just find what is bothering you and work on it.
Same thing but to automatically send emails to your local political representative. Bonus points if I don't even have to know who it is
Gave it a go. Seems like it has potential. I'm still working through an appeal. My wife ended up in the ER in May and was directly admitted to the hospital for emergency surgery. Ten days afterwards we received a letter from the insurance company saying they had decided it wasn't medically necessary so they wouldn't be paying the $67k bill.
It has been a journey trying to get the appeal together. I had hoped the hospital would at least assist with a letter from one of the many physicians that attended her, but nope. We got laughed at by the surgeons office and told condescendingly "Yeah, that's not how any of this works. "
My biggest concern from the AI generated appeals are being able to confirm the statements it is making isn't just a LLM hallucination. As a lay person, much of the things necessary to make an argument are paywalled out of reach. For example, the insurance company cited the "2023 InterQual criteria for Surgical Conditions" as the reason why they are denying it. The AI appeal that was generated states that per the 2023 InterQual criteria for surgical conditions that hospitalization was medically necessary.
The only way it seems you can actually get access to InterQual is as a medical provider / payer.
.... I thought most people actually just appealed most denials???
I was pretty sure this was already common knowledge?
90% of the time what happens is that you call up your insurance for some shit like hey my jaw be broken as fuck, and they go "nah thats cosmetic" and then you spend 2 weeks fighting with them until they cave and actually cover it.
you call up your insurance
They're "solving" this problem with less agents or customer service staff, automating the process so you have a robot to deal with that doesn't ever seem to understand what you're saying, and can't get you to the right place. Basically make it as hellish as possible to even get your issue reviewed. Then, they stone wall you and don't take yes for an answer no matter what
ah yes, this should be illegal, i don't care how much money it saves.
...This is just a network switch/router.
You sound like one of them fancy book reading types you get the fuck out! Lol
In an ideal ~~world~~ country, we would have a different system, but we don’t live in an ideal ~~world~~ country, so what I’m shooting for here is incremental progress and making the ~~world~~ country suck a little less,”.
It’s a good article. Don’t let that American exceptionalism creep into it.
my brother in christ, "in an ideal world" this string is a fucking turn of phrase.
The turn of phrase refers to things that are natural facts, human nature, stuff like that. This one isn’t any of those things, it’s weird to use it to refer to something specific to one country or place.
"a way of saying or describing something"
hmm.
"Rather, Washington’s national security establishment has unthinkingly internalized a Trump-era turn of phrase that is rife with unrealistic expectations and unvetted assumptions."
hmmmm.
We love some good news to start the day
Yeah, honestly the appeal is a standard step in the bottom surgery process in the states. I know one lady who had to explain to her insurer why removal of the penis was a necessary step in her vaginoplasty.
Hehe her dog is a donut hole with a PhD.
I think the PhD may be honorary in Timbit's case. Though I suppose if she has a doctorate as well, she may have used him as a rubber duck, and therefore given him credit on her Doctorate Thesis, thereby granting him a doctorate as well? I dunno if that would work.
You go human