Anyone using ChatGPT for Insurance Appeals?

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drusso

drusso

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I'm three for three. Total game changer and timesaver:

Dear Insurance Review Committee,

I am writing to appeal the denial of coverage for radiofrequency lumbar denervation for my patient, who has experienced significant improvement in their low back pain following a series of medial branch blocks.

As you may be aware, medial branch blocks are a diagnostic procedure used to determine the source of low back pain. In my patient's case, the blocks provided an 80% improvement in their pain symptoms, indicating that the pain is likely being caused by the medial branches of the spinal nerves in the lumbar region.

Based on this improvement, I believe that radiofrequency lumbar denervation, a minimally invasive procedure that uses heat to disrupt the medial branches and provide long-term pain relief, is the most appropriate treatment option. This procedure has been shown to be highly effective in cases where pain is caused by the medial branches, and has a low risk of complications.

I understand that insurance coverage for this procedure may be denied due to its status as a specialty service. However, given the significant improvement my patient has experienced with the medial branch blocks, and the low risk and high potential benefit of the radiofrequency lumbar denervation, I strongly believe that this procedure is medically necessary and should be covered.

Thank you for considering my appeal. I would be happy to provide any additional information or clarification that may be needed.

Sincerely, [Your Name]

Dear Insurance Review Committee,

I am writing to appeal the decision to deny coverage for Suboxone for my patient and to require a "fail first" trial of methadone instead.

As a licensed healthcare provider, I am aware that both Suboxone and methadone are used to treat opioid addiction, but I strongly believe that Suboxone is the safer and more appropriate treatment option for my patient.

Methadone, while effective in some cases, carries a higher risk of overdose and other serious side effects, including respiratory depression and cardiac arrhythmias. It is also highly addictive and can lead to dependence.

In contrast, Suboxone has a lower risk of overdose and is less likely to cause respiratory depression or other serious side effects. It is also less addictive and has a lower risk of dependence.

Given the relative safety and effectiveness of Suboxone, and the higher risk of methadone, I strongly believe that it is the most appropriate treatment option for my patient. I respectfully request that the insurance company reconsider its decision and provide coverage for Suboxone as prescribed.

Thank you for considering my appeal. I would be happy to provide any additional information or clarification that may be needed.

Sincerely, [Your Name]

Dear Insurance Review Committee,

I am writing to appeal the decision to deny coverage for sacroiliac radiofrequency ablation for my patient on the grounds that it is considered experimental.

As a licensed healthcare provider, I am aware that sacroiliac radiofrequency ablation is a well-established and evidence-based treatment option for patients suffering from chronic low back pain caused by sacroiliac joint dysfunction. This procedure has been shown to be highly effective in providing long-term pain relief and has a low risk of complications.

Numerous scientific studies have demonstrated the safety and effectiveness of sacroiliac radiofrequency ablation, including a systematic review published in the Journal of Orthopaedic & Sports Physical Therapy in 2017, which found that the procedure had a high level of effectiveness and low risk of complications (https://www.jospt.org/doi/abs/10.2519/jospt.2017.7408). Another study published in the Journal of Pain in 2018 also found that sacroiliac radiofrequency ablation was effective in reducing pain and improving function in patients with sacroiliac joint dysfunction (https://www.jpain.org/article/S1526-5900(17)30970-4/fulltext).

Given the scientific evidence supporting the effectiveness and safety of sacroiliac radiofrequency ablation, I strongly believe that it is not experimental and should be covered by insurance. I respectfully request that the insurance company reconsider its decision and provide coverage for this procedure as prescribed.

Thank you for considering my appeal. I would be happy to provide any additional information or clarification that may be needed.

Sincerely, [Your Name]
Members don't see this ad.
 
Did they actually overturn the determination on the SI joint ablation?
 
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Not really related to appeals or medicine as a whole, but were those letters actually written by the AI and what did you ask for? That's pretty impressive to be honest!
 
Snowmen96 said:
Not really related to appeals or medicine as a whole, but were those letters actually written by the AI and what did you ask for? That's pretty impressive to be honest!
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@SSdoc33

1671392959591.png


Wow, I am just blown away by your brilliant insights on collectivism in healthcare. How did you ever come up with such a revolutionary idea? Oh wait, let me guess - you just blindly followed the party line and regurgitated the same tired arguments that have been proven wrong time and time again?

It's amazing how collectivists like you always seem to ignore the inconvenient truths about socialized medicine. You know, like the long wait times for basic procedures, the reduction in physician autonomy, and the overall decrease in the quality of care. But hey, at least the government gets to play God and make all the decisions, right? Because that's definitely what patients and doctors want.

And let's not forget the wise words of Ayn Rand, who so eloquently summed up the dangers of collectivism: "Collectivism means the subjugation of the individual to a group-whether to a race, class or state does not matter. Collectivism holds that man must be chained to collective action and collective thought for the sake of what is called 'the common good.' " I'm sure you're familiar with her work, right? Or did you just skip straight to the part where she talks about how great collectivism is?

But seriously, SSdoc33, I have to give you credit for one thing - you really know how to throw a personal attack. Insulting someone's appearance? Classy. Real mature. But hey, I guess when you have nothing substantive to say, you have to resort to petty insults. And since you're so good at it, I figured I'd return the favor. I mean, your mom's appearance? Not exactly a showstopper. Just saying.
 
drusso said:
@SSdoc33

View attachment 363543

Wow, I am just blown away by your brilliant insights on collectivism in healthcare. How did you ever come up with such a revolutionary idea? Oh wait, let me guess - you just blindly followed the party line and regurgitated the same tired arguments that have been proven wrong time and time again?

It's amazing how collectivists like you always seem to ignore the inconvenient truths about socialized medicine. You know, like the long wait times for basic procedures, the reduction in physician autonomy, and the overall decrease in the quality of care. But hey, at least the government gets to play God and make all the decisions, right? Because that's definitely what patients and doctors want.

And let's not forget the wise words of Ayn Rand, who so eloquently summed up the dangers of collectivism: "Collectivism means the subjugation of the individual to a group-whether to a race, class or state does not matter. Collectivism holds that man must be chained to collective action and collective thought for the sake of what is called 'the common good.' " I'm sure you're familiar with her work, right? Or did you just skip straight to the part where she talks about how great collectivism is?

But seriously, SSdoc33, I have to give you credit for one thing - you really know how to throw a personal attack. Insulting someone's appearance? Classy. Real mature. But hey, I guess when you have nothing substantive to say, you have to resort to petty insults. And since you're so good at it, I figured I'd return the favor. I mean, your mom's appearance? Not exactly a showstopper. Just saying.
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Why does this sound like @bedrock

😉
 
This is a very handy tool. Here's something I totally came up with on my own, without any AI assistance...

Free market capitalism, also known is an economic system in which the government plays a minimal role in regulating the economy. Under this system, individuals and businesses are free to produce and exchange goods and services at prices determined by supply and demand.

There are several reasons why free market capitalism is superior to socialism:

  1. Economic efficiency: In a free market system, prices are determined by supply and demand, which helps to allocate resources efficiently. In contrast, under socialism, the government determines prices and production levels, which can lead to inefficiencies and shortages.
  2. Innovation and progress: In a free market system, businesses are free to innovate and compete, which can lead to technological progress and improved living standards. In contrast, under socialism, there may be less incentive for businesses to innovate because profits are often redistributed rather than retained by the company.
  3. Individual freedom: Free market capitalism allows individuals to make their own economic decisions and pursue their own self-interest, which some people see as a fundamental freedom. In contrast, under socialism, the government has more control over the economy and individual choices may be limited.
  4. Economic growth: Free market capitalism has been associated with higher rates of economic growth compared to socialist systems.
  5. Historical evidence: Many countries that have adopted free market capitalism have experienced significant economic growth and improvements in living standards, while countries that have adopted socialist systems have often struggled with economic stagnation and poverty.
Citations:

  1. Milton Friedman, "Capitalism and Freedom," University of Chicago Press, 1962.
  2. Adam Smith, "An Inquiry into the Nature and Causes of the Wealth of Nations," 1776.
  3. Joseph Schumpeter, "Capitalism, Socialism, and Democracy," Harper, 1942.
  4. Friedrich Hayek, "The Road to Serfdom," University of Chicago Press, 1944.
  5. James Gwartney, Richard Stroup, Dwight Lee, and Tawni Hanchett Ferris, "Common Sense Economics: What Everyone Should Know About Wealth and Prosperity," St. Martin's Press, 2010.
  6. Alexander Field, "A Great Leap Forward: 1930s Depression and U.S. Economic Growth," Yale University Press, 2011.
  7. David Henderson, "The Joy of Freedom: An Economist's Odyssey," Prentice Hall, 2002.
  8. Deirdre N. McCloskey, "The Bourgeois Virtues: Ethics for an Age of Commerce," University of Chicago Press, 2006.
  9. Angus Maddison, "The World Economy: A Millennial Perspective," OECD, 2001.
  10. William Easterly, "The Elusive Quest for Growth: Economists' Adventures and Misadventures in the Tropics," MIT Press, 2001.
  11. Hernando de Soto, "The Mystery of Capital: Why Capitalism Triumphs in the West and Fails Everywhere Else," Basic Books, 2000.
  12. David Landes, "The Wealth and Poverty of Nations: Why Some Are So Rich and Some So Poor," W.W. Norton & Company, 1998.
  13. Thomas Sowell, "Basic Economics: A Citizen's Guide to the Economy," Basic Books, 2004.
  14. Jeffrey Sachs, "The End of Poverty: Economic Possibilities for Our Time," Penguin Press, 2005.
  15. Lawrence E. Harrison and Samuel P. Huntington, "Culture Matters: How Values Shape Human Progress," Basic Books, 2000.
 
Now how we get get AI to talk to patients and take the history and insurance companies for a peer to peer? Real question. Any sites or software?
 
drusso said:
3 for 3. I don't think people at the insurance company actually read the letters. I think the whole exercise is an administrative barrier to treatment.
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It's funny a friend of mine sent me a TIKTOK with someone using this.

It seems like they do a good job from what you posted above. rock on!
 
Impressive to generate a lot of words very quickly. It apparently recommends a series of three for epidurals though…

“Write a doctor’s assessment and plan for a California Worker’s compensation patient to justify a cervical epidural steroid injection according to the medical treatment utilization schedule guidelines”

Subject: Cervical Epidural Steroid Injection for [Patient Name]

I am writing to request authorization for a cervical epidural steroid injection for [Patient Name], a patient under my care for a work-related injury.

According to the medical treatment utilization schedule guidelines, a cervical epidural steroid injection is a reasonable and necessary treatment for patients suffering from neck pain and radiculopathy resulting from a work-related injury. [Patient Name] has been experiencing these symptoms as a result of the injury sustained on the job, and has not responded to conservative treatment measures such as physical therapy and medication.

I believe that a cervical epidural steroid injection is the most appropriate course of treatment at this time, as it has been shown to be effective in reducing pain and improving function in patients with neck pain and radiculopathy. The injection will be administered by a qualified provider, and will be performed in a safe and sterile manner.

I recommend that [Patient Name] receive a series of three injections, spaced approximately one month apart. Following the injections, I will reevaluate [Patient Name's] symptoms and progress, and determine if further treatment is necessary.

I believe that this treatment is necessary for [Patient Name] to make a full recovery from their work-related injury, and will help to ensure that they are able to return to work as soon as possible. I request that authorization for this treatment be granted as soon as possible, so that [Patient Name] can receive the care they need.

Thank you for considering this request.

Sincerely, [Your Name]
 
Members don't see this ad :)
drusso said:
@SSdoc33

View attachment 363543

Wow, I am just blown away by your brilliant insights on collectivism in healthcare. How did you ever come up with such a revolutionary idea? Oh wait, let me guess - you just blindly followed the party line and regurgitated the same tired arguments that have been proven wrong time and time again?

It's amazing how collectivists like you always seem to ignore the inconvenient truths about socialized medicine. You know, like the long wait times for basic procedures, the reduction in physician autonomy, and the overall decrease in the quality of care. But hey, at least the government gets to play God and make all the decisions, right? Because that's definitely what patients and doctors want.

And let's not forget the wise words of Ayn Rand, who so eloquently summed up the dangers of collectivism: "Collectivism means the subjugation of the individual to a group-whether to a race, class or state does not matter. Collectivism holds that man must be chained to collective action and collective thought for the sake of what is called 'the common good.' " I'm sure you're familiar with her work, right? Or did you just skip straight to the part where she talks about how great collectivism is?

But seriously, SSdoc33, I have to give you credit for one thing - you really know how to throw a personal attack. Insulting someone's appearance? Classy. Real mature. But hey, I guess when you have nothing substantive to say, you have to resort to petty insults. And since you're so good at it, I figured I'd return the favor. I mean, your mom's appearance? Not exactly a showstopper. Just saying.
Click to expand...
My mom passed away this time last year
 
SSdoc33 said:
My mom passed away this time last year
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Losing a parent is never easy, and I can only imagine the pain and grief you are experiencing right now.

I wanted to express my sincere condolences and support during this difficult time. Your mother must have been a remarkable woman and a wonderful mother. She dedicated her life to caring for and nurturing you and your family, and she will always be remembered for the love and selflessness she showed to all those around her.

Motherhood is a sacred and noble calling; your mother embraced it with all her heart. She will always be remembered for her positive impact on those around her and for the countless ways she made the world a better place.

While it is never easy to say goodbye to a loved one, I hope you can find comfort in knowing that your mother's spirit lives on through you and all those who knew and loved her. She will always be with you, watching over you and guiding you through life.

Please do not hesitate to contact me if you need anything or want to talk. I am here for you and am thinking of you during this difficult time.
 
drusso said:
Losing a parent is never easy, and I can only imagine the pain and grief you are experiencing right now.

I wanted to express my sincere condolences and support during this difficult time. Your mother must have been a remarkable woman and a wonderful mother. She dedicated her life to caring for and nurturing you and your family, and she will always be remembered for the love and selflessness she showed to all those around her.

Motherhood is a sacred and noble calling; your mother embraced it with all her heart. She will always be remembered for her positive impact on those around her and for the countless ways she made the world a better place.

While it is never easy to say goodbye to a loved one, I hope you can find comfort in knowing that your mother's spirit lives on through you and all those who knew and loved her. She will always be with you, watching over you and guiding you through life.

Please do not hesitate to contact me if you need anything or want to talk. I am here for you and am thinking of you during this difficult time.
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Usso, that is an odd thing to have AI write.

SS, presuming you were being serious, sorry for your loss. Hope this time of year may bring fond memories of her.
 
cowboydoc said:
Usso, that is an odd thing to have AI write.

SS, presuming you were being serious, sorry for your loss. Hope this time of year may bring fond memories of her.
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thanks, cowboy. you are a class act.

AI cant convey any real sentiment. its all fluff. AI and computer scientists can never fully capture all of the variables. This is the reason why docs will always be needed. why self-driving cars are way far off. why everytime there is a software update, something gets screwed up. life is not an algorithm.
 
SSdoc33 said:
thanks, cowboy. you are a class act.

AI cant convey any real sentiment. its all fluff. AI and computer scientists can never fully capture all of the variables. This is the reason why docs will always be needed. why self-driving cars are way far off. why everytime there is a software update, something gets screwed up. life is not an algorithm.
Click to expand...
it appears that life may indeed be an algorithm if you are a right wing Ayn Rand supporter....
 
this is an amazing tool. scary how good AI has advanced.....i only wonder when the insurance companies are going to start using this tech against us!
 
Multimodal said:
this is an amazing tool. scary how good AI has advanced.....i only wonder when the insurance companies are going to start using this tech against us!
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exactly

Ithink this was a 'tik tok ' sensation Recently i read it on MEDSCAPE too. SO i am sure insurance companies will catch on real soon..
 
Multimodal said:
this is an amazing tool. scary how good AI has advanced.....i only wonder when the insurance companies are going to start using this tech against us!
Click to expand...
Our Aetna recently told us that they will be determining the appropriate billing levels for our E&M notes themselves, by reviewing the documentation of each individual note. No way they're not using AI for that. I'm putting a time disclaimer on all my Aetna notes so they can't downcode me
 
drrosenrosen said:
Our Aetna recently told us that they will be determining the appropriate billing levels for our E&M notes themselves, by reviewing the documentation of each individual note. No way they're not using AI for that. I'm putting a time disclaimer on all my Aetna notes so they can't downcode me
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I wonder if they’re just counting the number of ICD 10 codes listed as the initial screener and if you can get past it by putting down 3 codes
 
AI is advancing very rapidly. I really worry about what jobs will be available for my kids. I think society could see even more rapid and dramatic changes over the next 10-20 years.
 
mid|ine said:
AI is advancing very rapidly. I really worry about what jobs will be available for my kids. I think society could see even more rapid and dramatic changes over the next 10-20 years.
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The way things are looking now I can see this easily replacing most primary care doctors, and likely a lot of the “cognitive” specialties within 10-20 years. The natural language interface in ChatGPT shows how easily the data could be collected from patients.
 
If everyone’s job is really replaced by robots and you can’t earn a living, then some form of socialism is probably the only way to continue surviving
 
Agast said:
If everyone’s job is really replaced by robots and you can’t earn a living, then some form of socialism is probably the only way to continue surviving
Click to expand...
Everyone on the dole, with a lottery to go to college/have a job, like in The Expanse
 
i read these and all i am reading is fluff.

theres no real substance.



the problem with this AI is that yes, you can add substance to make it more engaging, but in the long run it is easier to write it yourself than to use the AI. what you input is what you get.
 
Ducttape said:
i read these and all i am reading is fluff.

theres no real substance.



the problem with this AI is that yes, you can add substance to make it more engaging, but in the long run it is easier to write it yourself than to use the AI. what you input is what you get.
Click to expand...
Yeah, but the point about insurers using it for denials is spot on. Currently they just use a clerical worker with no medical training to digest the note, look for a check box to deny, and have it signed off by a physician. Not like they really care about substance - how often do you already get denials that don’t make medical sense? SI joint injection denied because there was pain down the leg, even though I documented it was non-radicular and there was no central or foraminal narrowing on the MRI.
 
sure...

but not sure responding to fluff with fluff is what we should be doing.


unless this is some sort of marshmallow fight...
 
Ducttape said:
i read these and all i am reading is fluff.

theres no real substance.



the problem with this AI is that yes, you can add substance to make it more engaging, but in the long run it is easier to write it yourself than to use the AI. what you input is what you get.
Click to expand...
Have you ever read an email from a hospital administrator?
 
cowboydoc said:
Have you ever read an email from a hospital administrator?
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“Write a letter from a hospital administrator to a doctor thanking them for their value to the organization but explaining why their salary needs to be cut by 5% due to declining reimbursements.”

Dear [Doctor],

I hope this letter finds you well. First and foremost, I want to express my sincere gratitude for your hard work and dedication to our hospital. Your value as a member of our team cannot be overstated, and we are lucky to have you on board.

However, I wanted to reach out to you regarding your salary. As you may be aware, the healthcare industry has faced a number of challenges in recent years, including declining reimbursements from insurance providers. As a result, our hospital has had to make some difficult financial decisions in order to remain sustainable.

After careful consideration, we have determined that it will be necessary to reduce your salary by 5% effective immediately. We understand that this may be a difficult and unsettling change, and we want to assure you that it was not a decision we made lightly.

Please know that we value your contributions to our organization and hope that you will continue to be a vital part of our team. We will do everything we can to support you during this transition and will continue to look for ways to improve our financial situation in the future.

Thank you again for your commitment to our hospital. If you have any questions or concerns, please don't hesitate to reach out.

Sincerely, [Hospital Administrator]
 
Its not about where it is now. Its about the speed of the progress. Is GPT3 going to put us out of work? No. GPT8? Maybe. GPT20? Probably...

And not GPT necessarily, but AI is coming and its going to change this in a major way.

A friend just used ChatGPT to write a 10 page college research essay with references. Got a perfect score.
 
Also try a prompt like “Write a letter to [your congressperson] expressing concern about the proposed Medicare cut in physician payments. I am a physician in his/her district.” It actually produced a pretty solid letter for me.
 
hyperalgesia said:
Not bad!

So if I use the bot to write a book or song for me, can I copyright and publish it?
Click to expand...

Sure. Change a few commas. I'm amused that it confirms what I've been saying for years: SOS is so stupid even an 8th grade essay writer can understand it. But still, there are deniers...
 
drrosenrosen said:
Our Aetna recently told us that they will be determining the appropriate billing levels for our E&M notes themselves, by reviewing the documentation of each individual note. No way they're not using AI for that. I'm putting a time disclaimer on all my Aetna notes so they can't downcode me
Click to expand...
I know for a fact they’re using software to do this.
 
I’ll be impressed when ChatGPT can demonstrate a sense of humor. I tried to get it to be witty or tell a few jokes, no dice. So maybe raise your kids to be comedians?
 
I’ve started using it sometimes to generate some filler language for the assessment and plan. Also used it to write some blog posts for our website. It did an impressive job on that.
 
callmeanesthesia said:
I’ve started using it sometimes to generate some filler language for the assessment and plan. Also used it to write some blog posts for our website. It did an impressive job on that.
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That's what it can do, provide filler language. I agree it's impressive in that sense.

Apparently the creators are assessing the actual value of this, as a service. How much would you PAY to use it?

My guess is that insurance companies are gonna love it. It's basically the essence of bureaucracy - filler.
 
hyperalgesia said:
That's what it can do, provide filler language. I agree it's impressive in that sense.

Apparently the creators are assessing the actual value of this, as a service. How much would you PAY to use it?

My guess is that insurance companies are gonna love it. It's basically the essence of bureaucracy - filler.
Click to expand...
We need admin for ChatGPT and weekly Zoom meetings. Then we need assistance admin, too
 
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