Yesterday, I wrote about Brian Thompson, the CEO of a major health insurance company. He was murdered in cold blood by a coward who laid in wait. The slimeball who did it was probably a guy who got denied or who knew someone who got denied. Whomever he was, he had no right to take a human life over it all.
New information has emerged. UnitedHealthCare has been using an AI-driven program that makes approval or denial decisions 90% of the time. Because of this, copious amounts of people have seen claims or requests for authorizations denied. As a result, supposedly, people have died.
It should go without saying that no one deserves to be murdered for doing his or her job. Thompson was absolutely a victim, the victim of an evil monster who, moments before carrying out his horrid plans, was seen smirking and flirting with a female barista, his cowardly face exposed for all to see.
As for this AI program, I have no problem with it. As I wrote yesterday, I have, in the past, worked for a major insurance company. They too used an automated, AI system to adjudicate claims. I was told that the system made decisions 80% of the time, leaving the remaining claims to be handled by human processors.
I handled entering claims manually that were rejected by the system for missing information. I would send those claims to the processors. Then, the numerous denied claims were again handled by me. I would send out denial letters to the providers and our members. It was never personal. It was about underwriting guidelines. Everyone was treated fairly.
I didn’t have a problem then with claims being handled by software and I don’t have a problem with it today. But to be fair, I have rarely had any of my claims denied. Those that were denied were able to be changed to approved because I know how the system works and I know the appeals process. I have always gotten the care that I needed. Even if I didn’t, I would never dream about killing someone over it.
The problem, as I see it, is that too many people don’t know that there is an appeals process. I know and so do many others. Vast amounts of people consider the denial final and suffer physically or financially and spend their time whining on the internet rather than being proactive.
It appears that the vast majority of claims denied by UHC’s software were eventually adjusted to be approved. All it takes is a phone call and some patience, folks. No crying. No bitching about it. No playing the victim. Simply pick up the phone and get the appeals process going.
Yes, there are times that, once and for all, a claim is denied and people have to make other plans to secure the help that they need. This gunman, if he was out for revenge, did not need to kill anyone. All he had to do was let the system do its thing. But no, he’d rather slaughter a man who had nothing to do with his or his family member’s care.
Thompson was an innocent man. Perhaps the gunman knew that Thompson supported the AI system. That doesn’t mean that Thompson should have paid with his life. His job as CEO was to maximize the company’s profits and obtain massive ROI for his shareholders. It was nothing personal. It was always business.
Yes, health care in the United States is a multi-billion dollar industry. That doesn’t mean that company employees should be threatened or, in this case, murdered. People in other countries are looking at our country, wondering why we don’t have universal health care like, say, Canada and the United Kingdom do.
Well, as the folks in the ghetto say, don’t hate the playa, hate the game.