this post was submitted on 06 Dec 2024
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United States | News & Politics
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That's gonna take some time.
I don't know if the number was real but someone posted a picture that their denial rate was 32% whereas the lowest provider was 9%
Their denial rate was 8% when Brian Thompson became CEO and jumped to 22.7% after one year of his leadership. 32% is believable after 3 years, especially if it's true that the decision to train an LLM for the purpose of auto rejecting claims was his directive
Why a LLM when an autoreply of "Denied" would work?
Presumably because the LLM can give a justification as well, rather than just a straight "no". Doesn't mean it's a good justification but I'm sure they have metrics that say when it looks somewhat plausible that more people don't challenge it.
Isn't it their policy to deny every claim to force an appeal? How many claims do they get in a day? Their investigation will never end.
I believe their policy is deny, delay, defend.
Hence the depose.
Seems to me that this investigation is way over budget.
Seems like they should delay and deny an investigation and then defend that stance as a cost saving measure.
Yeah, New York has real problems.