Tag: medicare advantage

The Impact of AI on Medicare Advantage Claims Denials

Angela Linders
Medicare Advantage Claims Denials

A Growing Concern for Healthcare Providers In recent years, the integration of artificial intelligence (AI) in the healthcare sector has sparked significant debate, especially concerning its role in Medicare Advantage claims denials. As hospitals face mounting administrative burdens, the use of AI by insurance companies has been scrutinized for potentially prioritizing cost-saving measures over patient care. The Rise of AI in Insurance Between 2019 and 2022, insurance companies like UnitedHealthcare, Humana, and CVS began increasingly employing AI tools to automate the prior authorization process. These technologies, while designed to streamline…

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Health insurance companies can’t use AI for Medicare

Logan B.
Health insurance - Medicare and AI

Newly released federal guidelines say that artificial intelligence can’t make all the choices. The Centers for Medicare and Medicaid Services (CMS) have released new guidance for health insurance companies to protect Medicare Advantage (MA) against bias from artificial intelligence (AI). The CMS is the federal agency overseeing Medicaid, Medicare and other programs CMS oversees the Children’s Health Insurance Program (CHIP), the Health Insurance Marketplace, Medicare and Medicaid. It recently issued a policy memo to insurers in which it banned them from using algorithmic systems or AI exclusively to decide on…

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Mercy Health and Anthem strike health insurance deal

Logan B.
Health insurance - Deal - Handshake

The companies have come to an agreement that will keep the care provider in the insurer’s network. Mercy Health has announced that it will remain in Anthem’s health insurance network now that the companies have arrived at a deal. This means that the insurer’s members will be able to seek care through that healthcare system. The Catholic healthcare system in Ohio and Kentucky will be available to Anthem health insurance members on the Medicaid, Medicare Advantage and employer-based coverage plans. According to the new agreement, this will extend through to…

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Medicare Advantage health insurance plans don’t have many mental wellness services

Logan B.
Health insurance - Person seeing psychiatrist

A new study shows plan holders are struggling to find psychiatrists within their networks. New research findings are showing that people who are covered by private sector Medicare Advantage health insurance plans are struggling to find psychiatrists and other mental wellness services within their networks. As a result, people with private Medicare coverage might not be getting the care they require. Over half the counties studied by the researchers did not have a psychiatrist within a Medicare Advantage health insurance plan. That plan is the counterpart in the private sector…

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