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 »
In today’s rapidly evolving digital world, automation is becoming more prevalent across many industries, including insurance. Health and life insurance companies increasingly rely on automated systems to process claims. While this may seem like a step toward efficiency, the reality is that claim automation often works against policyholders; it can even result in the... Read More »
Health insurance is for everyone, and California law makes it clear that insurance companies are not allowed to impose exclusions, charge differentials, or other modifications of enrollee benefits based on race, color, national origin, ancestry, religion, sex, gender, marital status, sexual orientation, or age. One exception is that premiums, prices and charge differentials based... Read More »
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