General Discussion

Ms. Toad

(38,047 posts)

25. Gotcha. You believe it is appropriate to force me to choose between

Thu Dec 4, 2025, 11:05 PM

Thursday

Living with a cancer that is doubling every 2-3 weeks while waiting months for an appeal to an AI denial of a skin graft - or paying for it out of pocket and fight an insurance appeal while I'm fighting for my life. Not a hypothetical. It's my life.

Thanks a bunch.

I chose standard Medicare because it left medical decisions to the doctor and the patient. If a doctor is making inappropriate decisions, Medicare can deny the claim after the fact - and the doctor (not the patient) incurs the cost of the appeal (both money and time). If that happens too many times, they will pay better attention to their decision-making.

Turning Medicare into Medicare Advantage on steroids (using AI to make the decisions) is not the solution to the fraud you believe is occurring.

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SamuelTheThird GrapesOfWrath

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Highlight:

Medicare's new AI experiment sparks alarm among doctors, lawmakers [View all] marmar Thursday OP

Kick dalton99a Thursday #1

They get paid to avoid providing care Bettie Thursday #2

Isn't it, though! (n/t) OldBaldy1701E Thursday #5

Traditional WmChris Thursday #3

Kicking with DISGUST!!!! Faux pas Thursday #4

One Goal Is Likely To Deny Coverage For Diabetes 2 And Its Related... ColoringFool Thursday #6

Jeezus. Joinfortmill Thursday #8

Any use of AI in a customer service context is to be feared. "Speak to a representative" is my answer to what I want to Martin68 Thursday #7

AI learns that there's a reward for denying coverage. SergeStorms Thursday #12

AI finds it more cost efficient to let us die faster IronLionZion Thursday #19

there is help for patients Nigrum Cattus Thursday #9

Could you please elaborate for those of us who are not inclined to readily click links? mahina Thursday #13

Wow! Thanks Nigrum Cattus! That's a great source for fighting insurance denials! BComplex Thursday #16

The problem isn't the availability of an appeal - Ms. Toad Thursday #20

Arizona is a swing state with lots of retirees IronLionZion Thursday #10

They will likely never hear about it, or understand it was REPUBLICANS who passed this BComplex Thursday #17

If they are looking for fraud and corruption instead popsdenver Thursday #11

They want us dead orangecrush Thursday #14

Who in the F*** authorized this change?? BComplex Thursday #15

Medicare has used private contractors to review claims since at least 1980. The pilot program is limited to 6 states Silent Type Thursday #18

Requiring conservative therapy is a Medicare Advantage/Insurance concept - it has no place in Standard Medicare Ms. Toad Thursday #21

Absolutly incorrect. Original Medicare has extensive coverage policies. No, the patient won't pay because it'll be Silent Type Thursday #22

Gotcha. You believe it is appropriate to force me to choose between Ms. Toad Thursday #25

How many of those services have anything to do with diagnosing or managing cancer? Plus, Silent Type Thursday #26

It was in my post - a skin graft. Ms. Toad Thursday #28

There is a new policy on skin substitutes that removes the incentive for doctors making thousands of dollars off Silent Type Friday #29

Nonsense. Ms. Toad Friday #31

None of those are life threatening conditions. Let's be honest here. No it's not fantasy that it will happen quickly Silent Type Friday #33

And just now would you know "none of those were life threatening' Ms. Toad Friday #34

Because I can read. None of those are life threatening and most are questionable efficacy. Have no problem telling Silent Type 10 hrs ago #35

Sorry, but you don't know what those dozens of appeals related to, Ms. Toad 10 hrs ago #36

Talking about list of procedures requiring authorization. None of those are life threatening. Silent Type 10 hrs ago #37

Except, of course the denial of a skin graft, which delays surgery for an aggressive cancer - Ms. Toad 10 hrs ago #38

If you read the procedures listed, it's for BIOENGINEERED skin substitutes, not skin grafts following cancer surgery. Silent Type 9 hrs ago #39

Trump's government... LudwigPastorius Thursday #23

It's bad enough when some employee at an insurance company who is not a doctor IcyPeas Thursday #24

I love the name - WISeR. It's become a cliche to say that every pronouncement by this administration is Orwellian jls4561 Thursday #27

Crap UTUSN Friday #30

who needs a "death panel?" rampartd Friday #32