Actually, it did help. It made it clear to me that you don't understand how insurance carriers actually operate. Have a great Friday!

For example, if that well-baby check had been submitted for a six-week-old patient, from a general pediatrician, chances are good that there's no need for human eyes to review it. Which frees those human eyes to look at more complex claims instead.

Then it's probably a good thing that the law ALREADY requires that the clinical director for an insurance company be an M.D. or a D.O. -- and has for decades. Doesn't it?

AI is generally being used to auto-approve claims, not auto-deny them.

One of the funniest denials I ever saw was a doctor that had submitted a claim for a well-baby check on a 33-year-old patient. Even the patient thought it was funny when I unwound it for them -- and she herself told the doc to either resubmit it or eat it.

A healthy percentage of them get denied because the patient in question ISN'T COVERED by that particular insurer -- that is, the doctor sent the request to the wrong place. But doctors never tell you that's the reason it was denied; they just say "your insurance denied it."

Something like 85% of denied pre-authorizations are denied because of a lack of documented clinical need. Most of the time it's just providers that are too lazy to make sure their admins send it in, but there are times when the procedure really isn't clinically appropriate.

There are plenty of for-profit hospitals out there. They make bank and private equity's been sniffing around them. Not so insurance companies, who have a cap on profits.

They're the ones keeping your doctor from administering an asthma treatment to a diabetes patient. Yes, that has happened.

We can do it, though, if we take a phased approach. The problem is that literally NO ONE is going to allow that to happen.

[I had a large endometrial polyp right in front of my Fallopian tubes - basically, my body grew its own IUD. It wasn't visible on ultrasounds due to me having a retroverted and retroflexed uterus. But when actually went in to take a look, it was Right. There. And it came right out.]