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

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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Telehealth insurance claims from private policies up by 4,347 percent

Telehealth insurance claims - mobile phone and stethoscope

This trend was led by the Northeastern US, where the increased reached a much higher 15,303 percent. The latest FAIR Health report recorded a striking increase in the number of telehealth insurance claims in the United States, which rose by 4,347 percent compared to last year. This dramatic trend is directly linked with the coronavirus pandemic precautions since March. The leading reason that people filed telehealth insurance claims was for mental health conditions. The next most common reason for using these services was for respiratory diseases and infections, then joint/soft…

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Substance abuse and mental health insurance claims double in ten years

Mental health insurance claims - young woman stressed

Claims are more than twice what they were a decade ago and the increase is driven by young adults and teens. Substance abuse and mental health insurance claims have spiked over the last decade, more than doubling during that time, said a new report. Moreover, the driving force behind this staggering growth rate is young adults and teens. The report was published in May by FAIR Health, a nonprofit health care organization. The report showed that rates of anxiety and depression among Americans of all ages have been rising over…

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California health insurance regulators launches investigation into Aetna

Short Term Health Insurance - Regulators

The insurer’s coverage practices will be examined by the two different state departments. Two California health insurance regulators have stated their intentions to investigate Aetna’s coverage decision processes. This examination of the insurer is a result of a lawsuit filed by a Californian man. The man filed the lawsuit against the country’s third largest insurance company, alleging improper care denial. The two California health insurance regulators will conduct the investigation in order to help determine whether or not Aetna’s decision processes are acceptable. The opening arguments in the case were…

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Health insurance consumers face confusion over mental illness coverage

Health Insurance policies

Many people are struggling to understand what type of protection they have against mental conditions. Health insurance has been a prime news topic over the last while, as the changes to the Affordable Care Act are implemented, but what many people are still struggling to discover is how they are covered against mental illness. Standard policies will soon provide more protection against that type of condition. However, while it is truly helpful to have a policy that will provide mental illness coverage, all too many practitioners are not accepting that…

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Health insurance industry shows improved claims processing capabilities

Health Care Reform

Report targets the health insurance industry The American Medical Association (AMA) has released its fifth annual National Health Insurer Report Card. The report aims to rank the country’s health insurance companies based on their ability to serve customers and provides ratings based on issues such as transparency and business practices. According to this year’s report, the health insurance industry has made radical improvements to its operations. The report details these improvements and how they may be affecting consumers and highlights an issue that has garnered a great deal of interest…

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The insurance company’s strategy for finding fraud

Data from the Insurance Research Council has indicated that there is about $5 to $7 billion in inflated auto insurance claims made every year, though the overall cost that would occur if insurance companies in any sector did not make efforts to detect scams would be significantly higher. Every time fraudulent claims get past the insurers, the end result is that the cost will trickle down to the clients and lead to higher premiums. Therefore, insurance companies have put extensive efforts into place to help prevent scams from occurring in…

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