Always strive to learn something useful. --Sophocles

A tech worker in San Francisco needed surgery after an accident and faced a spate of claim denials, so she fought back, appealing all of them. And over 90% of the roughly 40 denials were approved on reconsideration. She even got a denial overturned on appeal for surgery for her pet dog!

So she started helping friends with the process.

Well, there's one thing about us programmers. When we start doing something repeatedly, we start thinking "How can we automate this and improve it?"

So she turned to large language models, commonly known as AI.

And it seems to be working pretty good!

Scan in your denial letter, and her system will generate several appeal letters for you to pick and choose from, you can also modify as you see fit.

A study showed that only about a tenth of one percent of rejected claims of participants in the ACA appeal. My doctor's office has handled this for me in the past, I've also joined in the fight a couple of times, and they've always been overturned thus far. It's definitely worth the fight, and this will make it a lot easier to do!

The actual web site is at: https://fighthealthinsurance.com/

She put a year of her time and $10,000 of her own money into this project! It's free for now, though she may charge for add-on services such as faxing an appeal directly to your insurance.

https://sfstandard.com/2024/08/23/holden-karau-fight-health-insurance-appeal-claims-denials/

https://science.slashdot.org/story/24/08/31/2131240/tech-worker-builds-free-ai-powered-tool-for-fighting-us-health-insurance-denials

It's an interesting problem. Insurance is a pool of shared risk. We all pay to insure our cars, but only a small number of us will have a loss through an accident or theft and need to make a claim, so insurance companies can be overall profitable.

The satellite insurance industry is a bit different. Take, for example, StarLink. Musk launches 30+ satellites in a single throw, expecting some will fail or won't reach orbit or whatever. He doesn't care. They aren't insured, and more will be going up soon enough to make up the coverage of the ones that didn't make it. And lots of people are having him launch lots of small satellites with the same philosophy. And there is the problem: they're not buying insurance, so while the number of satellites being launched is increasing, the pool is kinda static and not growing.

Enter ViaSat.

The launched an insured billion dollar satellite. Actually, they have a few in orbit. And there was a power supply failure on an absolutely critical subsystem. We're talking a subsystem that if it doesn't work, you've got a gigantic paperweight in orbit that can't do what it was launched for. Why said system was not multi-redundant, I do not know. They have another satellite in orbit that developed an antenna problem and is not working nearly up to spec. Also insured. These satellites could represent legitimate claims of over Seven Hundred Million U.S. Dollars.

From the article: "In 2019, the total losses from satellite claims amounted to $788 million, which overwhelmed the total premiums for the year at $500 million." The next year, three big insurers stopped offering satellite insurance.

What happens when insurance carriers stop offering insurance? Well, you can't buy it if they're not selling it. Do you build and launch a billion dollar satellite if you can't get insurance for it? California has a problem right now with car insurance: extremely hard for people entering the market to get it, or to get above bare minimum coverage at high prices as companies have been leaving the California market. So if your car gets totaled and you and the other guy both have bare minimums, you could be on the hook for a lot of money to get your car replaced if you still have a note against it!

Is space the next frontier? This could put a major crimp in the satellite industry.

https://finance.yahoo.com/news/billion-dollar-satellite-risks-upending-093002573.html

https://science.slashdot.org/story/23/09/04/0149214/how-a-billion-dollar-satellite-risks-upending-the-space-insurance-industry

Aside from the fly parking itself on Pence's head.

They showed a clip of Trump saying that "All American's" could get the exact same treatment that he got at Walter Reed. And IIRC, he said it would be free.

Let's check that.

Remdesevir. His administration let them get an exclusive on that, and I believe that treatment is now over $10,000 a shot.

The monoclonal antibodies that he got? Is still in trials and only nine people have otherwise gotten the emergency authorization for it. It is very effective, but monoclonal treatments are very expensive. And here's the best part: it's made from stem cells, so it shouldn't be available to any Republican that is against stem cell research.

And the free part? I expect our medical insurance might have a differing opinion on that.

Yeah. Sure.


There was one very big takeaway from the debates, but this has been developing for the entire time Trump has been in office, and that is the Republican desire to destroy the Affordable Care Act and eliminate coverage of pre-existing conditions. Trump has been promising since day 1 that "We're going to replace it with something EVEN BETTER AND CHEAPER!" But nothing has ever been proposed. IT. IS. AN. EMPTY. PROMISE. Which isn't in the least bit surprising. But let's leave that aside. After all, who knew that health care reform was so complicated?

Last week? Maybe the week before, Trump signed an executive order or two saying that he was ordering continued coverage of pre-existing medical conditions. Here's the thing. That does not mean shit. There is no legislation behind it. There is no legislative proposal behind it. It is a completely empty, meaningless gesture. Zero substance. Much like many things that I could compare it to, but I won't.

Meanwhile, the Administration is about to appear before the Supreme Court to try to get the remaining pieces of the Affordable Care Act declared invalid, which will truly destroy coverage of pre-existing conditions.

Do you know who has pre-existing conditions? President Trump. He contracted something called the Novel Coronavirus. So did 7.5 MILLION AMERICANS, of which TWO HUNDRED AND TEN THOUSAND OF THEM HAVE DIED. Well, I guess that last cohort don't have to worry about medical insurance. But those 7,500,000 do. And they're in serious danger of losing it. Not that Typhoid Donald will ever lose his health coverage - he'll have the best in American health protection for the rest of his *life, insert preferred adjective as desired.

The people who will lose their coverage?

People who are diabetic.

Or have high blood pressure.

Or asthma.

Or successfully fought off cancer. Had a heart attack or stroke?

Or who have immune disorders, primary or acquired.

Or any number of other conditions that I can't name, but guaranteed there are lists of.

Congratulations. You're going to die for the DOW.