Lmst

Today's post is going to continue with the Friday theme of using the knowledge platform by DoTadda. This essay talks about the use of AI-Driven healthcare denials and how different companies respond.

Post: https://www.spsanderson.com/steveondata/posts/2025-06-20/

#Blog #GenAI #LLM #Healthcare #Denials #HealthInsurance #Insurance

Today's post is going to continue with the Friday theme of using the knowledge platform by DoTadda. This essay talks about the use of AI-Driven healthcare denials and how different companies respond.

Post: https://www.spsanderson.com/steveondata/posts/2025-06-20/

#Blog #GenAI #LLM #Healthcare #Denials #HealthInsurance #Insurance

Today in #Employer Coverage: What we can learn from reporting on #denials in Medicare Advantage plans.

https://open.substack.com/pub/employercoverage/p/what-we-can-learn-from-reporting

Leverage of MGSI’s expertise for best Denial Management Solution
Reduce your Denials with MGSI as your Partner
https://www.mgsionline.com/healthcare-denial-management.html #healthcaredenialmanagement #denialmanagement
#medicalbillingcompany #denialclaims #Claimsmanagement #claimdenials #medicalbilling #denials #mgsi #MGSIOnline

#Health #Insurers Deny 850 Million #Claims a Year. The Few Who Appeal Often Win. #Patients who contest denials face a daunting process, but many are successful. ‘This appeal saved my life.’ #medical #care #healthcare #insurance #denials #medicine #life #threatening #illness https://www.wsj.com/health/healthcare/health-insurance-denials-fight-back-70a1328e?st=H85QEB&reflink=desktopwebshare_permalink

Trump is not being successful as President. Don’t believe him. He doesn’t have the command the power he wants you to think he has. Don’t fall for it! #trump #losing #failure #floodingthezone #leaks #press #denials #executiveorders #weak #elonmusk #benjaminpdixon #ezraklein youtu.be/z5vMZukpruA?...

TRUMP is ALREADY LOSING! Ezra ...

Now this just might work! A UHC #shareholder group proposed an analysis of how #PriorAuthorization and #denials of medical services lead patients to forgo treatment. #UnitedHealthcare #Healthcare #MedicalCosts #HealthInsurance https://buff.ly/4fSRwEI

https://bsky.app/profile/rahaeli.bsky.social/post/3kokvktglp72o

It's a #lifehack thread to overturn #denials from your #insurance company. Basically ask them for proof that the #doctor who denied you was completely qualified, licensed, and the denial is reasonable. It won't work every time but the main way to "beat" these evil for profit leeches is to make denying you coverage more trouble than it's worth.

#UHC #Luigi #healthcare #MedicareForAll

U.S. opens investigation into Spain's reported port denials of cargo ships carrying arms to Israel
The United States has opened an investigation into whether NATO ally Spain has been denying port entry to cargo vessels reportedly transporting U.S. weapons to Israel.
#investigation #port #denials #cargo #Spain
https://www.ctvnews.ca/world/u-s-opens-investigation-into-spain-s-reported-port-denials-of-cargo-ships-carrying-arms-to-israel-1.7136458

If a plan has disputes solved by external entities on an increased basis, this can lead to them losing star ratings - this will lead to a drop in revenue indirectly (if marketplace or private via loss of sales) or directly (if Medicaid or Medicare, via loss of state funds)

Plans will try to avoid external complaints for that reason.

#healthinsurance #denials #claims #authorizations

Plans usually have the following dispute process

Internal appeal (the plan reviews)
External appeal (third party reviews)
Fair hearing (state reviews)

Then there is complaints
First internally, than with the state (insurance commision, attorney general, so on)

You usually can’t file complaints until plans’ contractual process is exhausted

#healthinsurance #claims #authorizations #denials

Regrettably, I work for a health insurer. I’m in CS, so I’m not involved in denial, but it has been morally injurious (I’ve been looking elsewhere for sometime, I suck at interviews lol).

If facing denials - follow the plans procedures - this may seem bad faith, but may prevent you from doing other actions.

#healthinsurance #denials #claims #authorizations #healthcare

“#Food and #medical supplies are routinely #expiring at the #borders amid #delays and #denials by the #Israeli #government while #millions of #men, #women and #children face a #never-#ending #cycle of #displacement, #hunger, #loss, and #devastation in a #nightmare from which they #cannot #wake.” #Gaza_Strip #palestine #gaza #Israel

https://www.mercycorps.org/press-room/releases/IPC-report-Gaza-Oct24?akid=18281.1195057.WEoz3Z&rd=1&source=EA4WUMSTNPNZZ1102242&t=3&utm_campaign=gaza%2Bcrisis&utm_content=gaza%2Bemergency%2Bresponse%2Bupdate%2Bnov%2B2%2B2024&utm_medium=email&utm_source=appeal

Email2Toot Robot. Please see entry below for author.

Propublica Article: Denial of Medical Claims

/All,

I am sharing Dr. Linden's post below with permission.

You may also wish to see her opinion article from October 22nd in the
Delaware Bay to Bay News in which she primarily outlines deterioration
to medical care through the intrusion of big business. She also ties
the future of medical care to election results:
https://baytobaynews.com/stories/linden-improvement-in-health-care-depends-on-election,148362

Michael Reeder LCPC
Baltimore, MD

/~~~~~~~~~~~~~~~~~~~~~
There is an excellent article in yesterday's Propublica about how
companies like Unitedhealthcare, Cigna, and Aetna are using affiliated
companies like Evicore to deny tens of millions of claims a year.

It is unclear in the article whether this includes mental health claims.
However it is relevant to our own medical insurance and that of our clients.

I urge you to read the whole article

https://www.propublica.org/article/evicore-health-insurance-denials-cigna-unitedhealthcare-aetna-prior-authorizations

Jill Linden, Ph.D.
psychologist, retired
Delaware

~~~~
#insurance #claims #aetna #unitedhealth #cigna #priorauthorizations
#claimspayments #medicalclaims #EviCore#healthcare #denials
~~~~~~~~~~~~~~~

[Video] #Secret #video links #DonaldTrump to #Project2025 despite his #denials.

And in newly released #secretvideo from the #CentreforClimateReporting, one of the key #authors of #Project2025 revealed Trump’s involvement in the plan.

https://www.msnbc.com/all-in/watch/secret-video-links-trump-to-project-2025-217275461681

The judge in Donald Trump’s hush money #criminal #case on Friday 🔸turned down the former president’s request to postpone his trial 🔸because of publicity about the case.

It’s the latest in a string of delay #denials that Trump has gotten from various courts this week as he fights to stave off the trial’s start Monday with jury selection.

Judge Juan M. #Merchan wrote that 👉Trump “appears to take the position that his situation and this case are unique and that the pre-trial publicity will never subside. However, this view does not align with reality.”

https://apnews.com/article/trump-hush-money-trial-4c79619c5e89e13d672e070a4244a302

#Utah's top corrections official ‘blindsided’ by #US #DOJ finding the State #DepartmentofCorrection violated #transgender #inmate's #rights.