The Algorithm Will See You Now (And Kick Your Parent Out of Rehab)
How private Medicare Advantage insurers use secret software to predict recovery times and cut off nursing home stays before healing even begins.
Your 78-year-old mother fell and broke her hip. After surgery, she was admitted to a nursing home for rehabilitation, with the expectation of a standard 20-day stay covered by insurance. On day seven, a letter arrives stating her coverage is ending because she has met her recovery goals. She cannot yet stand without assistance, but a computer program she has never heard of just decided she is healed.
The direct answer
Private Medicare Advantage insurers use proprietary AI algorithms to predict exactly how many days of care a person needs based on historical data. These algorithms routinely override the actual opinions of treating doctors and therapists, issuing automated denials when a person hits a pre-programmed target day. To fight this, you must file an expedited appeal immediately, using the facility's daily therapy logs to prove your parent has not yet reached their baseline.
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