THIS TIME ON CODE WACK!
Imagine watching your mom suffer a stroke and two seizures that left her unable to use her right side… and then having her Medicare Advantage health insurer deny coverage for the nursing home care she desperately needs.
Now imagine learning that the decision to deny her coverage may have been based on artificial intelligence (AI) instead of clinical observation by a qualified medical professional!
Here to share this shocking personal story is Jeremy White, author of InHumana: An American Healthcare Story, published by White Lines Press. Jeremy and his wife, Edie, founded the award-winning satirical publication Red Shtick Magazine — and its online version, The Red Shtick. They live in Baton Rouge, Louisiana, near Jeremy’s mother. This is the first episode of a two-part series with Jeremy about his new book.
Check out the Transcript and Show Notes for more!
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SHOW NOTES
WE DISCUSS
Welcome to the show, Jeremy! You’re joining us from Baton Rouge. Tell us a little more about yourself, and how this situation with your mom got started.
White: “I have a degree in mechanical engineering, but I’ve never used it. I ended up somehow doing standup and producing standup shows and that turned into producing satire from a magazine to an online site that was eventually used as an $800 double jeopardy clue in the 2022 Tournament of Champions. And that was my opportunity to retire the site. Finally, kinda like John Elway going out on top, like … ‘That’s it. I’m never gonna top this.’
“But we did get an opportunity to write this book after my first book, about my wife Edie finding her biological family in 2018 and the crazy story that ensued from that. It was a beautiful story. And so we published that in July of 2023.
“Less than two months later, Edie and I are at the emergency room with my mom and she’s waiting to be admitted for a stroke. And this was late August, 2023.”
Tell us what happened then –
White: “… it was initially just weakness on her right side and [as] Edie and I watched that afternoon, her previously impressive vocabulary dwindled down to basically two words: ‘help’ and ‘clean.’ A few other words might come through, but they were just window dressing.
“That was at the Thursday evening admission. Friday is her first full day at the hospital and things aren’t looking too bad. We’re looking at possible transfer to an inpatient rehab facility by Monday. And so we’re starting to get ready for that.
“Unfortunately, two massive seizures that Friday night sent mom to the ICU for three days, took away use of her right side … she comes out of the ICU Tuesday, her feeding tube comes out and that’s when we’re visited by a friend, a long-time physician friend who came and visited.
“And he suggested one facility that we might wanna look at and we did on Wednesday. And then on Thursday, as we’re waiting to find out if Humana would cover transfer to this facility, he repeated something in a text … something he said in the room two days earlier.
“He said ‘the good thing about this facility is that they have people there who exist just to fight Humana.’ And that echoed everything we had learned that entire week there at the hospital.
“We had been asked innumerable times about mom’s insurance and … every time we said Humana, Humana Gold Plus, her Medicare advantage plan, we got a reaction that just cast further doubt on her decision to enroll with them. We had visible shivers from a couple of people I can remember. Like we told them something icky, like ugh. That’s how we got here with this story of InHumana, an American healthcare story.””
And that’s consistent with how Humana treated your mom’s case. She experienced repeated denials of care from Humana. And you appealed, over and over. Tell us about the appeals process, and in the end, what you learned –
White: “We learned about this on the fly. It’s a very nebulous process. Nobody knew anything about it. Even our brother-in-law who does administrative law hearings for social security benefits, they knew nothing about this.
“And what we learned was, you have your first appeal. It goes to the provider (like we did with Humana at the inpatient facility). If they deny, your second level is to the QIO (Quality Improvement Organization), the third party arbiter. And that was Maximus. So we went through that level. So the next level is an administrative law hearing.
“… The thing we learned later on, afterwards … we learned a lot of stuff that demystified what seemed in real time was just BS and gaslighting.
“[Anyway] we eventually learned it’s artificial intelligence that’s driving all of this. Unregulated artificial intelligence that are making all the decisions concerning post-acute care.
“Every Medicare advantage member is subjected to AI-driven denials for post-acute care. It doesn’t matter if it’s Humana, United Health. All of them use some kind of an artificial intelligence model to determine that, and they’ll tell you it’s predictive or whatever. But in practice, it’s determinative.”
Helpful Links
InHumana: An American Healthcare Story, Jeremy White
Private health insurers use AI to approve or deny care. Soon Medicare will, too, NBC News
Reconsideration by the Medicare Advantage (Part C) Health Plan, CMS.gov
Did Your Health Insurance Claim Get Denied? AI Might Be the Culprit — and the Fix, CNET
HOW TO FIGHT A HEALTH INSURANCE DENIAL: 7 ESSENTIAL TIPS, Healthpoint
NAIC Survey Reveals Majority of Health Insurers Embrace AI, National Association of Insurance Commissioners.
Episode Transcript
Read the full episode transcript.
Guest Biographies: Jeremy White
Jeremy White is the author of InHumana: An American Healthcare Story. His mom’s stroke came weeks after Jeremy independently published The Little Girl at the Bottom of the Picture: A Journey of Selfless Discovery, detailing how his wife, Edie, discovered her biological family in 2018 and the beautifully insane journey that ensued.
Before the tenured cynic penned a hopeful book, Jeremy and Edie founded the award-winning satirical publication Red Shtick Magazine, as well as its digital progeny, The Red Shtick, which served as an $800 clue in the 2022 Jeopardy! Tournament of Champions.
During that same time, Jeremy spent many years performing stand-up comedy, officiating high school and college football, and captaining a Mardi Gras krewe. A Cajun raised by a French-speaking family along the bayous of Terrebonne Parish, Jeremy earned a bachelor’s degree in mechanical engineering at LSU, where he met Edie. They’ve been happily married since 1992 and live in Baton Rouge with their cat, Waffles.
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