Why don't you tell me the story of Francis Walter? What happened to her?

Francis Walter had suffered an injury. She had fallen and broken her shoulder.

That's Casey Ross, National Technology Correspondent at Staten.

She had an acute hospital stay. So she stayed in the hospital for some period of time and

had a surgery to repair her shoulder and then was discharged to a nursing home.

And once she got into the nursing home, an algorithm was run about her care to suggest how long

she ought to be in the nursing home. This algorithm, a hidden aspect of Medicare Advantage Insurance

Plans, looked through Francis's past health records and considered how long other patients typically

need care when recovering from this kind of injury. It determined she only needed 16.6 days to recover.

And on the 17th day, she gets a notice from her insurer, security health plan of Wisconsin,

that she no longer meets Medicare coverage criteria to continue to stay in the nursing home.

She doesn't know anything about this algorithm and neither does her family.

Francis had a number of other health complications. And despite with the algorithm determined,

17 days just was not enough time. At that point, she can't dress herself. She can't

push her walker without assistance. And she can't carry on sort of basic activities of daily living.

And you have to remember that this is a person who's 86 years old. You don't just bounce back

from an injury like that. You need to have some amount of rehabilitation care so that you can

get to the point where you can again live independently. More and more, insurance companies are

relying on algorithms like this to make life and death decisions for patients. What's meant to be

a reference point to estimate the level of care a person might need is increasingly being taken as

facts. You'd expect that an insurance company would be carefully reviewing the details of her care

and making a decision based on that, which is the law, by the way. That's, you know, you're supposed

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