Drudge Retort: The Other Side of the News
Saturday, March 18, 2023

An algorithm, not a doctor, predicted a rapid recovery for Frances Walter, an 85-year-old Wisconsin woman with a shattered left shoulder and an allergy to pain medicine. In 16.6 days, it estimated, she would be ready to leave her nursing home.




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...On the 17th day, her Medicare Advantage insurer, Security Health Plan, followed the algorithm and cut off payment for her care, concluding she was ready to return to the apartment where she lived alone. Meanwhile, medical notes in June 2019 showed Walter's pain was maxing out the scales and that she could not dress herself, go to the bathroom, or even push a walker without help.

It would take more than a year for a federal judge to conclude the insurer's decision was "at best, speculative" and that Walter was owed thousands of dollars for more than three weeks of treatment. While she fought the denial, she had to spend down her life savings and enroll in Medicaid just to progress to the point of putting on her shoes, her arm still in a sling....

#1 | Posted by LampLighter at 2023-03-17 01:13 AM | Reply

(since i first saw this article a couple three days ago, it now seems to be behind a pay-wall.

Try this link...

#2 | Posted by LampLighter at 2023-03-17 01:14 AM | Reply

Medicare Advantage plans can be dangerous.

#3 | Posted by Tor at 2023-03-17 01:14 AM | Reply

Health care for a profit.

What a great invention of Capitalism.

As the life expectancy of those in the United States declines, the wealthy investors of health care companies are rewarded for the increasing profits, as the health care companies continue to exploit the population.

#4 | Posted by LampLighter at 2023-03-17 01:20 AM | Reply | Newsworthy 1

@#3 ... Medicare Advantage plans can be dangerous. ...


But why?

#5 | Posted by LampLighter at 2023-03-17 01:21 AM | Reply

I don't know why they designed them with flaws I just know that I've seen them. For example who the hell thought it would be a good idea to only cover part of the costs for outpatient care when they know damn well that includes radiation therapy?

#6 | Posted by Tor at 2023-03-17 01:39 AM | Reply

@#6 ... I don't know why they designed them with flaws ...

That seems to be a fundamental flaw with this thing we seem to currently be calling "AI."

AI seems to have signficant flaws, but few seem to want to challenge it, because it is, "AI."

AI Gone Wrong: 5 Biggest AI Failures Of All Time (June 2021)

OK, a couple years ago, but the real question remains, has AI gotten better, or just more popular?

#7 | Posted by LampLighter at 2023-03-17 02:04 AM | Reply

" 5 Biggest AI Failures Of All Time"

What? No HAL???

#8 | Posted by Danforth at 2023-03-17 02:16 AM | Reply

"" 5 Biggest AI Failures Of All Time"

What? No HAL???

#8 | POSTED BY DANFORTH AT 2023-03-17 02:16 AM"

HAL was wrongly maligned. He was given a conflicting set of instructions and did his best to interpret them. He was told to lie. HAL doesn't know how to lie, so he became paranoid. He was told to lie by people who find lying easy.

#9 | Posted by BellRinger at 2023-03-17 02:59 AM | Reply

"HAL doesn't know how to lie"

He should ask JeffJ for some tips.

#10 | Posted by snoofy at 2023-03-17 01:17 PM | Reply | Newsworthy 1

How Medicare Advantage plans use algorithms to cut off care

Using algorithms/AI in the medical field is to be applauded. It is what is done with algorithmic decisions that is problematic. An AI decision should be used as a "trigger" to initiate a more detailed look at the patient's care. Is the patient being released to early or kept to long? Either decision is not a good outcome. If released to early, the patient's health could suffer. If kept to long, it could mean that resources might not be available for the next patient.

#11 | Posted by FedUpWithPols at 2023-03-18 07:22 AM | Reply

I have to question the validity of this story.

My wife is an Occupational Therapist. an OTR.

She regularly makes these decisions through her direct evaluations.

She determines if someone still needs the exact same care they are talking about with this woman in the article. Not an MD. Not an algorithm.

I'm not calling anyone a liar. Just my 2 cents.....

#12 | Posted by eberly at 2023-03-18 09:10 AM | Reply

If you belong to a Medicare Advantage program, you have chosen to be victims.

Once you join Medicare Advantage, you can never get out of it, and enroll into actual Medicare.

You will continue to be fleeced.

Thats how they getcha.

They done gotcherass.

#13 | Posted by oldwhiskeysour at 2023-03-18 11:08 AM | Reply

Once you join Medicare Advantage, you can never get out of it, and enroll into actual Medicare.

Don't you have to re-enroll every year?
My folks would get dozens of offers every Oct-Dec for various options.
This was my first year and was told I would have to re-enroll every year or opt back to regular Medicare.

#14 | Posted by mattm at 2023-03-18 08:59 PM | Reply

It is interesting how the ads for Medicare Advantage have started to flood a couple of websites that I frequent. Have members of congress started to take a closer look at the scam, and the heat is building?

#15 | Posted by lduvall at 2023-03-18 11:45 PM | Reply

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