Ross: Artificial Intelligence bringing a non-human approach to health care

I’m at the age where after a doctor’s visit I’ll get a form letter basically saying — we just paid one of your medical bills, please prove it’s legitimate.

The medical insurance companies are trying to control fraud of course, but it makes you feel like a criminal for daring to see a doctor. I accept it – like I accept my TSA patdowns at the airport.

However, this system is now taking a disturbing turn– thanks to AI.

An article from Kaiser Health News tells the story of Judith Sullivan, who was in a nursing home recovering from surgery when she got a letter from her Medicare Advantage plan informing her that they would stop paying for her nursing care because she was well enough to go home.

And it turns out that her insurer, United Healthcare – full disclosure, also my insurer – uses an Artificial Intelligence tool to predict when patients should be ready to go home. The A-I examines millions of medical records, finds patients with the same medical issues, and then estimates how long it should take you to recover.

It’s similar to the way the IRS flags potential tax cheats.

They want to flag hospitals that might try to make an extra buck by keeping perfectly healthy people strapped in their beds.

Well, speaking as someone who’s had to recover from major surgery, I’d have bolted from the hospital the moment I came to… if it hadn’t been for the tubes stitched to my body. Why would anyone hang around a hospital longer than they have to? Unless they REALLY love the Jell-O?

United Health wouldn’t answer questions about the case… but obviously this is how those plans can charge lower premiums. They cut expenses.

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In Judith Sullivan’s case, there’s a semi-happy ending – her nursing home agreed to keep her for another 18 days, even though her insurance wouldn’t pay.

So she’s back at home and is healthy enough to sue her Medicare Advantage plan to reimburse her for the bill, which came to $10,406.36.

So far, however, the courts have sided with the company. I’m guessing that like most of us, she didn’t read the fine print in her insurance plan.

But come January, new federal rules will require that if your Medicare Advantage plan cuts you off, you have to be cut off by a human being who knows your case, not by an oblivious computer. That’s reassuring, right?

By the way, according to the article, had Judith stuck with regular government Medicare instead of buying a private Medicare Advantage plan… yes, her premiums might have been higher, but the recovery time would probably have been paid for.

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