I keep talking about the electronic data all the time on healthcare claims and here’s a perfect example of how the automatic electronic algorithm messed up. What makes this case more ridiculous is the fact that someone at the insurance company didn’t look into this further before it went to court.
The surgical stitches he received for a cut on his hand were denied payment.
In today’s economic times people are afraid of raising any concern over losing their jobs and this looks like it could be what happened here. As an employee you use that algorithm, go the the computer screen and get your answer. God forbid you question it as this the equivalent of the World of God when it comes to decisions today. I doesn’t have to be that way but the unfriendly fear environments cause the situations to rise when people are afraid to ask questions for fear of drawing negative attention to themselves.
With this stupid law suit that nobody had enough common sense to evaluate and this is how the health insurers live and die with those algorithms. For all those that go non contested, there’s a word for that called “profit”, so in essence when you come full circle here, they really want the issue raised but there are times when someone should so they don’t look stupid when lawsuits as such go to court.
This is one big reason why the levels of trust are gone today with health insurers and these practices go on with each consumer having to fend for themselves 
against business intelligence software that says “no”. By the way, part of your premiums payments go to support this software too if you were not aware.
Most of our leaders are somewhat non participants too that can’t seem to get their heads around this either to make and create some laws to protect consumers and we do need algorithmically centric laws in healthcare. Here’s a post I made on that topic a year ago.
Are We Ever Going to Get Some Algorithm Centric Laws Passed for Healthcare!
The answer lies in “Algorithmic Centric Laws”, no 2 ways about it, and the smarts to rethink the way we create laws, otherwise they end up being useless and protect nobody. From what I read in the news I don’t smart directions here and see more of a focus from Congress addressing the OMG stuff floating around out there today, but I’d have TMZ or someone else who does that stuff be my source. BD
Dean Health Plan, a Madison-based HMO, has settled a lawsuit alleging wrongful denial of an insurance claim (Watch Out!, 6/24/10). Andrew Erlandson, a local attorney who filed the suit on behalf of Joe "Kay," says the insurer agreed to pay $3,250, several times more than the $646 it initially refused to pay.
"He'll get the claim plus interest, and [our law firm will] get the rest," says Erlandson of the settlement. He adds that Kay rejected Dean's request to keep the settlement's terms confidential.
Kay's story came to light in an Isthmus article about the state Office of the Commissioner of Insurance ("Unable to Resolve Your Complaint," 10/22/09). Kay complained that Dean refused to pay the cost of stitches when he went to the emergency room with a cut hand, deeming this an "ancillary" service — which is, on its face, ridiculous. OCI, a state agency funded entirely by the insurance industry it supposedly regulates, did not challenge Dean's denial or even insist that it provide a clear explanation. (Dean has refused to discuss the case with Isthmus, citing patient confidentiality rules.)
Dean Health Plan pays to settle lawsuit - Isthmus | The Daily Page
0 comments :
Post a Comment