Are Bots to Blame for Your Medical Debt?

Perhaps you have heeded one of those roadside billboards or cheap TV commercials and called a personal injury lawyer if you were struggling with medical bills after a car accident.  When you went to the consultation, the lawyer probably explained that car insurance companies are in the business of protecting their financial interests, not in the business of looking out for your health.  Insurance companies pay as little as they can get away with and hope that claimants will not notice or that the claimants will be too overwhelmed with stress, financial and otherwise, to do anything about it.  Of course, it is not only car insurance companies that do this.  Health insurance companies, which ostensibly exist to keep people in good health, do the same thing.  In other words, no matter the cause of your illness or injury, the insurance company may deny your doctor’s claim for pre-approval, alleging that the treatment you need is medically unnecessary.  If you think that everyone with a brain knows that someone with appendicitis needs an appendectomy, you are onto something; maybe the one making the decisions about which treatments are medically necessary is someone without a brain, namely a computer algorithm.  If unfairly denied insurance claims are making your medical debt worse, contact a Philadelphia debt relief lawyer.

Health Insurance Companies May Be Paying a Tech Company to Program Its Algorithms to Deny Your Claims

The Pro Publica website published a disturbing report about the technology company that plays an outsized role in determining which claims health insurance companies approve.  EviCore is a software company that uses algorithms to determine whether a proposed medical treatment is medically necessary.  You might think that human doctors are in a better position than bots to decide what is medically necessary, and you are right, but it gets worse.  According to Pro Publica, the major health insurance companies have instructed EviCore to change its algorithms so that they deny a greater share of claims; they euphemistically refer to this as “moving the dial.”  In other words, if a health insurance company wants to save more money, it can just adjust the algorithms so that they deny claims that the old version of the algorithm would have approved.  As you can probably guess, this has nothing to do with medicine and everything to do with money.

The Pro Publica report has plenty of horrible stories of people dying from treatable illnesses because the pre-approval algorithms denied coverage for treatments that they desperately needed.  Even if your situation is not the worst-case scenario, you might be struggling financially because of medical debt arising from unfairly denied claims.  A debt relief lawyer can help you decide how to address this debt.

Contact CONSUMERLAWPA.com About Medical Debt

A Philadelphia consumer law attorney can help you if medical debt resulting from unfair insurance claim denials is causing you stress.  Contact CONSUMERLAWPA.com to set up a free, confidential consultation.

Source:

propublica.org/article/evicore-health-insurance-denials-cigna-unitedhealthcare-aetna-prior-authorizations