Category: Health Coverage

Daily articles posted on health insurance changes for all lines of business. Whether you are an agent or a small business owner you will be captivated in how much this industry is changing in the United States today.

AI in Health Insurance Claims Denials Sparks Controversy

G. Turner
Health Insurance Claims Denials

Artificial intelligence (AI) has revolutionized many industries, but its use in health insurance claims processing is stirring sharp debate. Health insurance giants like Cigna, Humana, and UnitedHealth Group are facing serious allegations over their use of algorithm-driven systems to deny claims at a staggering rate. With lives at stake and lawsuits piling up, the practice has raised deep ethical and legal concerns. The Allegations Against Industry Leaders The controversy largely centers on accusations that AI algorithms are being used to wrongfully deny claims, often in mere seconds. One lawsuit claims…

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Building Bridges in Healthcare and Insurance: How Collaboration Lowers Costs and Improves Care

Guest Author
Healthcare and Insurance

Sharing Expertise for Better Coverage and Outcomes Healthcare and insurance are deeply connected—both fields thrive on teamwork. When doctors, nurses, insurers, and pharmacists align their efforts, patients benefit from smoother care and fewer financial surprises. By combining clinical expertise with insurance knowledge, professionals create a system focused on cost-effective, high-quality outcomes. Insurance providers play a key role here. Whether connecting patients with in-network specialists or ensuring treatments align with coverage plans, collaboration helps avoid unexpected bills. Imagine a collaborating doctor working with insurers to pre-approve a surgery or medication. This…

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Can AI Really Decide Your Medical Needs? Texas Says Not Alone

Ben Jones
AI in Health insurance claims

Texas Senator Pushes for Stricter AI Regulations in Health Insurance Claims AI in Health Insurance: A Double-Edged Sword The health insurance industry is increasingly turning to artificial intelligence (AI) to streamline processes like patient claims. AI promises faster results, reduced administrative costs, and fewer delays. However, as Texas lawmaker Senator Charles Schwertner highlights with his recently proposed legislation, this growing reliance on AI also comes with serious risks—especially when AI systems replace human expertise in critical medical decisions. Schwertner introduced a bill on January 16 that aims to limit the…

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Tragedy, Reform, and the State of Health Care – A Look at UnitedHealth Group

Marc
Health Care

A Shocking Loss That Shook a Nation The murder of Brian Thompson, the CEO of UnitedHealth Group’s UnitedHealthcare division, stunned the country in December 2024. Thompson, a 50-year-old husband and father of two, was fatally shot while walking to a company meeting in New York City. It was a crime that not only horrified his colleagues and family but also put a harsh spotlight on the broader frustrations with the U.S. health care industry. The accused, Luigi Mangione, reportedly had grievances about systemic issues in the health care system. He…

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California Health Insurance Law SB 1120 Takes a Stand Against AI-Driven Health Insurance Denials

Angela Linders
California Health Insurance Law

California Enacts SB 1120 to Rein in AI-Powered Health Insurance Decisions California has taken a groundbreaking step in regulating the role of artificial intelligence (AI) in health insurance decision-making. Senate Bill 1120 (SB 1120), also known as the “Physicians Make Decisions Act,” prohibits health insurers from denying, delaying, or altering claims solely based on AI algorithms. Signed into law by Governor Gavin Newsom, this legislation ensures human oversight in healthcare coverage decisions, addressing mounting public concerns about fairness and accuracy in the use of AI technologies. Effective as of January…

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