I’ve been fighting with my insurance company since May. My wife had a medical emergency and I had to take her to the ER at 3AM on a Sunday. The team of doctors treating her all agreed she needed to be hospitalized and have emergency surgery. She was admitted and underwent surgery and was out in three days.

A week after she was discharged we received a letter from the insurance company letting us know they had decided not to cover the $67k hospitalization bill because they had decided it wasn’t medically necessary.

So yeah, that’s great. Not to mention we had finally hit our $6,000 deductible (after I had cardiac issues and ended up in the ER the previous month) so insurance would finally have had to actually pay something.

So glad we pay them $1500 a month for them to make decisions on what is medically necessary and what constitutes an emergency after the fact.

Howdy! I deleted this comment myself. I was having trouble posting an image and gave up.

Gave it a go. Seems like it has potential. I’m still working through an appeal. My wife ended up in the ER in May and was directly admitted to the hospital for emergency surgery. Ten days afterwards we received a letter from the insurance company saying they had decided it wasn’t medically necessary so they wouldn’t be paying the $67k bill.

It has been a journey trying to get the appeal together. I had hoped the hospital would at least assist with a letter from one of the many physicians that attended her, but nope. We got laughed at by the surgeons office and told condescendingly "Yeah, that’s not how any of this works. "

My biggest concern from the AI generated appeals are being able to confirm the statements it is making isn’t just a LLM hallucination. As a lay person, much of the things necessary to make an argument are paywalled out of reach. For example, the insurance company cited the “2023 InterQual criteria for Surgical Conditions” as the reason why they are denying it. The AI appeal that was generated states that per the 2023 InterQual criteria for surgical conditions that hospitalization was medically necessary.

The only way it seems you can actually get access to InterQual is as a medical provider / payer.

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I tried. Even got a degree in German Language & Literature. Took additional language courses through the Goethe Institute in DE, etc.

Though I’ve spent the last twenty years as a software developer (which is classified as an Engpassberuf), I was told that the regulations would only allow me to seek work based on the skills from that degree (Berufsqualifikation).

“We already know how to speak German.”

Too slow to the party it seems, has been removed from archive.org as well. :(

I still use this one! Makes me feel like a fancy lad.

I read this Wired article a couple months ago that though long does do a really good job of covering the company, its culture, and the issues with trying to run a factory in the U.S. : https://www.wired.com/story/i-saw-the-face-of-god-in-a-tsmc-factory/