I keep stating that the algorithms run by health insurance companies need to be certified just like EMR algorithms for medical records, so here’s a 
perfect example of algorithms gone wrong. How can a health baby just a few months into the world be severely “scored” like this? The insurer has since stated they would adjust their underwriting procedures (algorithms) to allow the baby and others like this to be covered, oh those algos up to it again!
“Department of algorithms – do we need one of these to regulate ...
Interesting when you watch the video they reference “the system”, and the “system” is the “algorithms.” Again, if you learn nothing else at this blog than the meaning of that word, the computer formulas used against those who are ignorant, you are miles ahead.
Is algorithmic fraud becoming a business model for healthcare? Somebody had to do the programming here, so who did it? It’ not a system that does it on it’s own, someone has to give approval to run them in their present format, so again with all the discrepancies' we see and bad billing, why not certify the insurers algorithms so we don’t have more cases like this one. BD
DENVER - A Colorado insurance company is changing its attitude about fat babies.
Rocky Mountain Health Plans said Monday it will no longer consider obesity a "pre-existing condition" barring coverage for hefty infants. The change comes after the insurer turned down a Grand Junction 4-month-old who weighs about 17 pounds. The insurer deemed Alex Lange obese and said the infant didn't qualify for coverage.
Fat baby can get coverage after all, insurer says - Kids and parenting- msnbc.com
This baby is not fat. They get a bit chubby before each time they grow taller. WTF is wrong with this greedy, evil corporate demoniac who signed that denial (or stamped)? And how is this not illegal? What happens if this baby has an emergency of some kind? Who is the first name on the list of who should be sued if this child even gets an untreated fever??? HR3200 REFORM NOW PEOPLE!
ReplyDeleteMoral of the story here is to stop wasting all this money on "insurance" wake up folks, be an informed consumer. Only physicians provide the services, not third party payors.
ReplyDeleteWhy do third party payors continue to dictate care? why do consumers not demand transparency of price of health services? why do physicians continue in the cat and mouse game of third party contracts? why do companies not contract directly with providers of primary care for better services for their employees?
Innovation, transparency, participatory and consumer directed care, is the only cure for what ails us in health care.
Natalie Hodge MD FAAP
Co-Founder Personal Medicine
www.personalmedicineinternational.com
"Your Doctor Comes to You"