The United States Plans To Regulate Technology Restricting Medicare Advantage Healthcare Services

In a decision that would provide relief to millions, the U.S. government would soon be reviewing the insurance plans under the Medicare Advantage plan. This plan is usually provided by private insurance firms that are similar to Medicare but are often known to be part C. It is generally known to cover all the costs pertaining to hospital stays, drug refills, and outpatient care. The move to add surveillance to the working of Insurance companies comes after various complaints. The most recent case comes from Connecticut where Judith Sullivan was cut off the  Medicare Advantage plan when she wasn’t clearly ready to do so.

The U.S. Aims To Regulate Technology Limiting Medicare Advantage Healthcare

Judith was not the first person to find herself in a precarious position. Earlier this year, Ken Drost had to go through the same problem as he expected the Wisconsin security plan to cover his health bills. So how does it decide when to stop the benefits?  Companies like United Healthcare make decisions based on high-end software like Navihealth. The company uses software to weigh in all the parameters of a particular coverage and then ascertain its viability. Depending heavily on predictive technology, its results often vary and are way off base.

Elaborating about her condition Sullivan said, “How could they make a decision like that without ever coming and seeing me? I still required the support of one physical therapist behind me and another beside me to walk. Were they all coming home with me?” According to Sullivan, she had not recovered fully yet as the stitches were still in place and she couldn’t even bear to walk or climb stairs.

Though she appealed many times, she was unsuccessful which ended up with her incurring a bill of over 10,406 $. Collected over 18 days, the algorithm failed to clock in her recovery days after a major surgery, and this affected her severely. Most of them are past 60 and for them, a bill like this is extremely exuberant. Many doctors have also voiced against the unlevel field.  Post-surgery care is as crucial as the surgery itself.  Over 4.2 Million people in the U.S. alone succumb to their injuries within a mere 30 days of their surgery completion. The status is extremely scary and the climbing health bill only adds insult to the injury.

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The new law would be looking at each case individually rather than one size that fits all. It will guarantee that medical necessity decisions consider the unique circumstances of each individual, rather than relying on algorithms or software. In each case handled by insurance companies, a licensed medical doctor will provide their expert opinion. When asked about this move, a social worker expressed her delight at the move. According to her and numerous other healthcare workers, this will “close a gap” between the privileged and unprivileged who are often handed the short end of the stick and end up paying a huge price.

If the companies are found to be breaking laws explicitly, they will be awarded “a civil money penalty or an enrollment suspension.” It could be severe depending on the intensity of the harm caused to the insurance taker and the extras they had to pay. The president of the Post-acute and Long-term Medicine Society expressed his elation, “When an algorithm does not fully consider a patient’s needs, there’s a glaring mismatch. That’s where human intervention comes in.”  Though the timeline is yet to be fixed the beginning of the New Year could be when things will finally look up.

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