THIS TIME ON CODE WACK!
Will Humana and UnitedHealth Group be found by the courts to have prematurely denied or cut off physician-ordered post-acute care for Medicare Advantage members using AI models with error rates as high as 90%? And could these same AI tools, which over 60% of doctors allege systematically deny patients necessary care, be used in Traditional Medicare as well? The answer is YES, depending on where you live.
To learn more, we spoke with Jeremy White, author of InHumana: An American Healthcare Story, published recently 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. This is the second 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
After your mom’s shocking experience with her Medicare Advantage plan, what do you wish people knew about those plans before signing up for them?
White: “… I knew nothing about them beforehand except those slick ads that they air this time of year … the fourth quarter… during open enrollment. … It was a crash course for us for sure.
“Actually I have a nurse friend who … will tell everybody to stay away from Humana, stay away from Medicare Advantage, stick with traditional Medicare because you don’t get the denials that you do in Medicare Advantage because it’s government insurance. [Traditional Medicare is] not a for-profit company managing your government benefits with … artificial intelligence.
“… I wish I would’ve known artificial intelligence was making all the decisions. That would’ve … demystified everything. But we didn’t know at the time and I wish I would’ve known that.”
You mentioned some class action lawsuits against United Health and other insurers. What are the plaintiffs suing for?
White: “For the unregulated use of artificial intelligence and the fraud aspect of it … by denying coverage.
“The fact that they know that fewer than 10% of denials are appealed, but if you appeal and you fight it, you have a 90% success rate. So the 10% is an indictment of how hard it is to fight these denials.
“David versus Goliath, what are you gonna do? Okay, yeah, alright, ‘we’re screwing you. What are you gonna do about it?’ But the 90% tells you how wrong those denials are. If nine and 10 are being overturned, what does that tell you about the denials in the first place?”
What do you think is the core problem with our healthcare system? Can we fix it?
White: “Fundamentally, the problem we’re gonna have – and it doesn’t matter what policy we institute here and there – as long as there is a way for someone to profit off of other humans’ misery, it will be exploited no matter what.
“You can put all the slogans you want, you can have all the nice words and corporate speak all you want on your ads. But the bottom line is our healthcare system is set up so that the medical industrial complex quietly throws away countless lives out the back door like Mrs. Lovett discarding from her pie shop, the unbaked parts of people who made the tragic mistake of entrusting their lives with her business partner, Sweeney Todd.
“And as long as there is that ability, the option to profit off of human misery, whether it’s the medical industrial complex, the military industrial complex, or chattel slavery, as long as that temptation is there, it will be exploited.
“ … we’re Americans, we brag about being able to figure things out and work out solutions. Okay, let’s do that. But the problem is, in this country we have too many people who are more interested in their net worth than they are in the human condition.”
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
Class action lawsuit against UnitedHealth’s AI claim denials advances, Healthcare Finance News
UnitedHealth uses AI model with 90% error rate to deny care, lawsuit alleges, Ars Technica
Denied by AI, Stat News
HOW TO FIGHT A HEALTH INSURANCE DENIAL: 7 ESSENTIAL TIPS, Healthpoint
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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