AI tools generated nearly $1B in extra costs, Blue Cross insurers say | Hacker News Reader

AI tools generated nearly $1B in extra costs, Blue Cross insurers say

reuters.com

22 pointsEA-316712 comments

Reminds me of the GameStop controversy where the “wrong” set of users used the existing market tools.

I presume the insurance providers thought they would be the only ones using the AI tools to auto-process (find creative ways to reject) insurance claims.

Even just the fact that people might learn about their rights, or find better ways to express their issues with correct wording would yield higher approvals, which would mean lesser profit margins for providers. And of course they will lobby for additional government subsidies.

I found this article confusingly written, so I'll summarize:

A health insurance cartel is asserting that AI-enhanced diagnostic assistance tools (such as medical record scanning or ambient voice transcription during consultations) is resulting in an increase in diagnosed "secondary conditions" without a corresponding increase in treatment of those conditions. Despite being untreated, these secondary conditions still cost the insurers money because they allow doctors to label a medical case as "complex".

I'm still confused where the money is going. Are providers getting more money for the same treatment because of the "complex" label?

At my recent physical I had to sign a form acknowledging that if I mention specific concerns they are allowed to bill my insurance twice. The example given said the physical is only for general health and if I mention a concern like 'ear pain' they will bill it as a second assessment. So double the money for the same amount of time because the AI voice assistant said so.

Sounds like insurance companies just want yo preserve their bottom line and using AI as a scapegoat.

Sounds like AI ROI is overpromised and underdelivering

It sounds like the ROI from the doctors standpoint is great, it's the insured that end up bearing the cost without receiving a corresponding increase in care

Rising healthcare costs are bad for both insurers and consumers, yes. I'm not sure why you say AI is a "scapegoat" here - they seem to be making a plausible case that the AI tools are directly causing this cost increase and it doesn't correspond to an increase in services provided.

More like the healthcare providers found a way to milk the insurance. The most important aspect that is amiss is the outcome of the patient's treatment. But if the practice of background mining to upgrade the claims is correct, I don't see how it can help the patients.

Nothing in America's healthcare system is designed around helping the patient.

Since their profits scale linearly with costs, this is a big win for the industry.

They're talking about their own costs.

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