Artificial intelligence (AI) has revolutionized industries worldwide, promising greater efficiency, cost savings, and improved decision-making. In the health insurance sector, insurers have embraced AI to automate claims processing, detect fraud, and assess risks. While these advancements sound promising, the reality for many insured individuals has been far less optimistic. AI is increasingly being used... Read More »
When you purchase health insurance, you trust that your insurer will be there when you need them the most—during times of illness or injury. Unfortunately, it often seems like insurance companies prioritize corporate profits over policyholder needs, even to the extent of employing tactics to deny legitimate claims. We take a look at some... Read More »
Handling a health insurance claim is often challenging, especially when dealing with lesser-known entities like Carelon. If you’re a California consumer whose health insurance claim has been denied, it’s crucial to understand the role companies like Carelon play in managing claims and their relationship with larger insurers, such as Anthem. Below, we delve into... Read More »
Insurance companies are increasingly relying on artificial intelligence (AI) to make decisions about health insurance claims. While AI has the potential to improve efficiency, it raises significant concerns about fairness and legality when it comes to handling claims. California law requires insurers to conduct a thorough, individualized review of every claim, and decisions made... Read More »
Two Blue Cross insurance plans were recently fined a total of $8.5 million by the California Department of Managed Health Care (DMHC) for failing to acknowledge and resolve provider disputes within the time frames required by law. These serious failures on the part of Blue Cross could ultimately harm patient care and are indicative... Read More »
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