Archive for March 25th, 2023
Suspicions confirmed: How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them
Patrick Rucker, Maya Miller, and David Armstrong report in ProPublica:
When a stubborn pain in Nick van Terheyden’s bones would not subside, his doctor had a hunch what was wrong.
Without enough vitamin D in the blood, the body will pull that vital nutrient from the bones. Left untreated, a vitamin D deficiency can lead to osteoporosis.
A blood test in the fall of 2021 confirmed the doctor’s diagnosis, and van Terheyden expected his company’s insurance plan, managed by Cigna, to cover the cost of the bloodwork. Instead, Cigna sent van Terheyden a letter explaining that it would not pay for the $350 test because it was not “medically necessary.”
The letter was signed by one of Cigna’s medical directors, a doctor employed by the company to review insurance claims.
Something about the denial letter did not sit well with van Terheyden, a 58-year-old Maryland resident. “This was a clinical decision being second-guessed by someone with no knowledge of me,” said van Terheyden, a physician himself and a specialist who had worked in emergency care in the United Kingdom.
The vague wording made van Terheyden suspect that Dr. Cheryl Dopke, the medical director who signed it, had not taken much care with his case.
Van Terheyden was right to be suspicious. His claim was just one of roughly 60,000 that Dopke denied in a single month last year, according to internal Cigna records reviewed by ProPublica and The Capitol Forum.
The rejection of van Terheyden’s claim was typical for Cigna, one of the country’s largest insurers. The company has built a system that allows its doctors to instantly reject a claim on medical grounds without opening the patient file, leaving people with unexpected bills, according to corporate documents and interviews with former Cigna officials. Over a period of two months last year, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of 1.2 seconds on each case, the documents show. The company has reported it covers or administers health care plans for 18 million people.
In the two minutes and 45 seconds you’ve been on this page, Cigna’s doctors could have denied 198 claims, according to company documents.
Before health insurers reject claims for medical reasons, company doctors must review them, according to insurance laws and regulations in many states. Medical directors are expected to examine patient records, review coverage policies and use their expertise to decide whether to approve or deny claims, regulators said. This process helps avoid unfair denials.
But the Cigna review system that blocked van Terheyden’s claim bypasses those steps. Medical directors do not see any patient records or put their medical judgment to use, said former company employees familiar with the system. Instead, a computer does the work. A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity.
“We literally click and submit,” one former Cigna doctor said. “It takes all of 10 seconds to do 50 at a time.”
Not all claims are processed through this review system. For those that are, it is unclear how many are approved and how many are funneled to doctors for automatic denial.
Insurance experts questioned Cigna’s review system.
Patients expect insurers to treat them fairly and meaningfully review each claim, said Dave Jones, California’s former insurance commissioner. Under . . .
Artistic nudity in 6th-grade classrooms
A kerfuffle erupted in Florida when parents were not notified in advance that their sixth-grade child would be in a class where Michelangelo’s David would be displayed as part of the art curriculum. Some parents objected because of the genitals displayed on the statue.
Kevin Drum has an excellent discussion of the matter on his blog. He quotes the report in the Washington Post:
We don’t have any problem showing David. You have to tell the parents ahead of time, and they can decide whether it is appropriate for their child to see it….No one has a problem with David. It’s not about David.
I pointed out Drum’s post on Mastodon and got some pushback from someone who said that the parents who objected were “oversensitive” (meaning, I think, that they were more sensitive than he, who has the right amount of sensitivity).
This conflict of opinions is exactly what I talked about in an earlier post, and so I thought I’d use the resolution I suggested there: submit it to Opinionate.io — not to settle the matter, but just curious of what the AI would conclude.
I submitted this proposition: “Schools should be allowed to show art with nudity to sixth-grade students without notifying parents in advance.”
You can read the full debate. The Moderator concluded:
Discussions surrounding art with nudity in schools are always difficult due to the possible implications at stake hence, kudos to both debators for handling such an issue. However, Debator B presented strong arguments regarding the right of parents to choose, and the importance of an appropriate school environment for young children. As such, I declare Debator B the winner of this debate.
I note that the AI in Opinionate is not so intelligent as to know how to spell “debater,” but the overall argument is interesting. Debater A gave another indication of a lack of intelligence by remarking a couple of times that parents could opt out, apparently overlooking the part of the proposition that parents would not be notified in advance (and thus would have no opportunity to opt out, the very problem the principal created).
Parents in general want what is best for their children, but they do not always agree on what that is. Some will take the view that their own idea of what is best should apply to all parents. I don’t think that position is defensible in any honest way.
How to use garlic powder and granulated garlic
I have to admit that I’ve been a bit of a fresh-garlic snob, based on my idea that fresh is best. But I do eat some dried and powdered foods — amla powder, for example — and the lack of good taste from the dried garlic I’ve used (powder or granulated) was because I did not know how to use it right. From Cook’s Illustrated:
A little research in formed us that here was more going on here than the garlic flavor’s solubility in water and fat. Garlic develops flavor when its cells are ruptured, releasing an odorless sulfur-containing amino acid called alliin and the enzyme alliinase. These two react to produce the primary flavor component in garlic: allicin (which is soluble in both fat and water). Garlic powder producers are careful to dry garlic at temperatures low enough to remove water without destroying alliinase, which will happen at temperatures higher than 140 degrees. Once the water has been removed, the enzyme exists in an inactive state. Only with the reintroduction of water does alliinase “wake up” and begin producing allicin.
Adding garlic powder as-is to the mashed potatoes allowed the powder to hydrate in the potatoes’ natural moisture, so allicin was able to form. The sample with garlic powder sautéed in butter, on the other hand, tasted dull because the alliinase had been exposed to high heat and thus any chance of allicin forming was eliminated.
It’s important to first “wake up” the dormant flavor-producing enzyme in garlic powder [or granulated garlic – LG] by hydrating it—and to avoid heating the powder before doing so since that will destroy the enzyme.
With this in mind, we came up with the following approach to bringing out the most flavor from garlic powder for our mashed potatoes: We first hydrated 1/2 teaspoon of garlic powder in an equal amount of water, which reactivated the alliinase and allowed allicin to form, and then sautéed the hydrated powder in butter before stirring it into the potatoes, which contributed the most complex garlic flavor.
In sum, when using garlic powder, for the fullest flavor hydrate it in an equal amount of water and then sauté it in fat before adding it to your dish.
And see also this article in the Washington Post.
AI warning: “You Can Have the Blue Pill or the Red Pill, and We’re Out of Blue Pills”
A very interesting column in the NY Times by Yuval Harari, Tristan Harris, and Aza Raskin.
Mr. Harari is a historian and a founder of the social impact company Sapienship [and the author of the (very interesting) book Sapiens – LG]. Mr. Harris and Mr. Raskin are founders of the Center for Humane Technology.
The column begins:
Imagine that as you are boarding an airplane, half the engineers who built it tell you there is a 10 percent chance the plane will crash, killing you and everyone else on it. Would you still board?
In 2022, over 700 top academics and researchers behind the leading artificial intelligence companies were asked in a survey about future A.I. risk. Half of those surveyed stated that there was a 10 percent or greater chance of human extinction (or similarly permanent and severe disempowerment) from future A.I. systems. Technology companies building today’s large language models are caught in a race to put all of humanity on that plane.
Drug companies cannot sell people new medicines without first subjecting their products to rigorous safety checks. Biotech labs cannot release new viruses into the public sphere in order to impress shareholders with their wizardry. Likewise, A.I. systems with the power of GPT-4 and beyond should not be entangled with the lives of billions of people at a pace faster than cultures can safely absorb them. A race to dominate the market should not set the speed of deploying humanity’s most consequential technology. We should move at whatever speed enables us to get this right.
The specter of A.I. has haunted humanity since the mid-20th century, yet until recently it has remained a distant prospect, something that belongs in sci-fi more than in serious scientific and political debates. It is difficult for our human minds to grasp the new capabilities of GPT-4 and similar tools, and it is even harder to grasp the exponential speed at which these tools are developing more advanced and powerful capabilities. But most of the key skills boil down to one thing: the ability to manipulate and generate language, whether with words, sounds or images.
In the beginning was the word. Language is the operating system of human culture. From language emerges myth and law, gods and money, art and science, friendships and nations and computer code. A.I.’s new mastery of language means it can now hack and manipulate the operating system of civilization. By gaining mastery of language, A.I. is seizing the master key to civilization, from bank vaults to holy sepulchers.
What would it mean for humans to live in a world where a large percentage of stories, melodies, images, laws, policies and tools are shaped by nonhuman intelligence, which knows how to exploit with superhuman efficiency the weaknesses, biases and addictions of the human mind — while knowing how to form intimate relationships with human beings? In games like chess, no human can hope to beat a computer. What happens when the same thing occurs in art, politics or religion?
A.I. could rapidly eat the whole of human culture — everything we have produced over thousands of years — digest it and begin to gush out a flood of new cultural artifacts. Not just school essays but also political speeches, ideological manifestos, holy books for new cults. By 2028, the U.S. presidential race might no longer be run by humans.
Humans often don’t have direct access to reality. We are cocooned by culture, experiencing reality through a cultural prism. Our political views are shaped by the reports of journalists and the anecdotes of friends. Our sexual preferences are tweaked by art and religion. That cultural cocoon has hitherto been woven by other humans. What will it be like to experience reality through a prism produced by nonhuman intelligence?
For thousands of years, we humans have lived inside the dreams of other humans. We have worshiped gods, pursued ideals of beauty and dedicated our lives to causes that originated in the imagination of some prophet, poet or politician. Soon we will also find ourselves living inside the hallucinations of nonhuman intelligence.
The “Terminator” franchise . . .
They raise an interesting point. Vision is a key sense for humans — “seeing is believing” — and in matters of our relationship and decisions, language plays the role of vision: we depend heavily on language to “see” in the sense of understanding, of persuading and being persuaded. When AI gets a little better, it will be able use language to play us like a violin.
Later in the column:
Social media was the first contact between A.I. and humanity, and humanity lost. First contact has given us the bitter taste of things to come. In social media, primitive A.I. was used not to create content but to curate user-generated content. The A.I. behind our news feeds is still choosing which words, sounds and images reach our retinas and eardrums, based on selecting those that will get the most virality, the most reaction and the most engagement.
While very primitive, the A.I. behind social media was sufficient to create a curtain of illusions that increased societal polarization, undermined our mental health and unraveled democracy. Millions of people have confused these illusions with reality. The United States has the best information technology in history, yet U.S. citizens can no longer agree on who won elections. Though everyone is by now aware of the downside of social media, it hasn’t been addressed because too many of our social, economic and political institutions have become entangled with it.
Large language models are our second contact with A.I. We cannot afford to lose again. But on what basis should we believe humanity is capable of aligning these new forms of A.I. to our benefit? If we continue with business as usual, the new A.I. capacities will again be used to gain profit and power, even if it inadvertently destroys the foundations of our society.
A good Cuppa Joe and a goodbye to the Aristocrat
Cuppa Joe seemed a good soap for today, a coffee day. Phoenix Artisan’s Astraeus 22mm shaving brush did a good job and the lather was quite good. If you click the photo you can easily read the ingredients in this Mystic Water shaving soap:
Tallow, Water, Ricinus Communis (Castor) Seed Oil, Glvcerin, Potassium Hydroxide, Butyrospermum Parkii (Shea) Fruit, Persea Gratissima (Avocado) Oil, Elaeis Guineensis (Palm) Oil, Sodium Hydroxide, Fragrance, Stearic Aod, Lanolin, Aloe Barbadensis (Aloe Vera) Leaf Juice, Allantoin, Citric Acid.
Bentonite, Silk
I did not especially notice the clay, but the overall lather was excellent. I wish I could say the same about the razor. For the first time I noticed that my 1940s Gillette Aristocrat is not really very comfortable, at least not compared to the modern razors I’ve been using. In fact, I did the third pass with my Phoenix Artisan Filament slant.
I did not get any nicks or cuts, but the threat of damage was very present, so the shave was not comfortable. The Aristocrat is now in the outgoing box.
A splash of Phoenix Artisan’s coffee-inflected aftershave, Spring-Heeled Jack, finished the shave and launched the weekend.
The caffeine this morning is Fantastico’s Guatemala Santa Clara Alto Dos: “Full-bodied, rich, balanced – Chocolate hazelnut cream pastry, vanilla, subtle red berry.”
Later On 