Health Insurance Coverage Disappears Mysteriously – It’s the Algorithms – He Was Reinstated More Than Likely with Some Human Intervention and Additional Analysis Investigations

One more time for all of those still living in or bordering on “tech denial” this is the process that does the dirty work – algorithms to where you and your claims get “scored” and cancellations too can be done on an automated process. So when you get cancelled from health insurance with a letter sent out, there’s a good chance this was an entirely automated process, it’s the way the formulas work with health insurers. There’s a real good chance not a human hand touched this case when cancelled; however, to reinstate that process more than likely involved a human to make exceptions and to run further algorithmic formulas to justify the reason for the reinstatement. Algorithms were even discussed at DAVO this year, they impact our decision making processes all over the place.

Do Algorithms Run Your Life – Bill and Melinda Gates Foundation Commits $10 Billion for Vaccine Research Over the Next 10 Years To Use Them Wisely And Save Lives – Davos 2010

We need to get smart here and really understand how and why this happens. I spoke recently to an individual that though all claims were reviewed by humans for approval, get a clue, they are not. I try to bring this awareness around here all the time. We need to fight algorithms with our own. Get as much of your own data as you can ready to fight the battle.

How to Fight Algorithmically “Scored” Health Care Claim Denials – Line Up and Deliver Your Own Data

Algorithms are going further too with predicting your behavior, called “behavioral underwriting”, so don’t miss this one as it is alive and happening.

Behavioral Underwriting With Biometric Employee Screenings – Red Brick Secures 3 More Clients

You can see news articles all over the web about this process and how it is developing. It’s all about the data and now biometrics are entering the picture to create even more data for scoring and evaluation purposes. I like technology but somewhat hold my breath here as we have not quite figured out how to live without disruption with cell phones yet, so add on some additional interactions and go figure? It can be helpful but at what “potential disruptive” cost? Implementation is key and we don’t always get that with many start ups having a limited amount of venture capital funding as they need money on the books quickly.

Wellpoint Enters Contract Agreement with Red Brick for Behavioral Underwriting

Long and short of all this, please read up and know where the processes are coming from so we can all be better educated on how to do battle and are not over run with big business using algorithmic formulas for profits only, some algorithms are good and help develop better healthcare standards too, but we need to know the difference. BD

The Schaumburg resident, who has multiple sclerosis, takes thousands of dollars' worth of medicine every month.
After he was laid off from Schiller Park-based Wisconsin Tool and Stamping Co. on Jan. 23, 2009, Shaw paid his premiums religiously so he could continue his Blue Cross and Blue Shield insurance through COBRA.
There were some bumps in the road, but throughout his year on COBRA his claims had always been paid.
Until he got a call from his doctor's billing office on Jan. 6. The doctor's office said bills for a series of recent tests, unrelated to his multiple sclerosis, had been denied by his insurance company.
Shaw said he immediately called Blue Cross and was given shocking news. His policy had been canceled, all the way back to Nov. 1.

Shaw said he experienced a similar situation in September, when his coverage was briefly canceled, then reinstated.
"Blue Cross claimed it was canceled by Wisconsin Tool and Stamping," he said. "What the reason for the cancelation was, I am not privy to."

Health insurance disappears, reappears - chicagotribune.com