The lawsuit alleges UnitedHealth used nH Predict to deny claims despite the algorithm’s determinations being overturned in more than 90% of appeals.| Healthcare Dive
More than 80% of denied requests were overturned when appealed, but few beneficiaries formally questioned the decisions.| Healthcare Dive
The insurer is the latest to be hit with a suit over its use of algorithms to appraise claims.| Healthcare Dive
Major insurers have agreed to six commitments that should make accessing care easier for patients while removing administrative burden on providers. But, the pledges’ voluntary nature makes compliance an open question.| Healthcare Dive
The insurer shrank its plan footprint for 2025 in a bid to improve margins. Now, Humana is giving market watchers loose guidance into how that reduction could affect its enrollment along with second quarter results.| Healthcare Dive
Star ratings bonuses reached $12.8 billion, according to the KFF, as the Medicare program faces a growing spending crisis.| Healthcare Dive
The Biden administration is attempting to push through a slew of reforms to the controversial MA program in its final months in power, though it will need the Trump administration’s buy-in to get them across the finish line.| Healthcare Dive
Deputy Administrator Jon Blum signaled regulators could increasingly crack down on bad actors in the MA program, which now covers more than half of Medicare seniors.| Healthcare Dive
Payers have new deadlines to issue prior authorization decisions — 72 hours for urgent requests and seven days for non-urgent ones — that should cut back coverage determination limbo for patients.| Healthcare Dive
“Insurers are in effect denying Americans necessary care in order to fatten and pad their bottom lines, and that phenomenon is unacceptable,” Sen. Richard Blumenthal, D-Conn., said at a subcommittee hearing.| Healthcare Dive
The payer lost 262,700 Medicaid members in the second quarter, dropping its total Medicaid lives to just over 16 million.| Healthcare Dive
The CMS proposed a 0.2% dip in MA rates. However, analysts said regulators will likely improve the payment rate in the final notice.| Healthcare Dive
Despite heavy lobbying, insurers failed to see MA rates improve in the final rule, which codified a 0.16% decrease to benchmark funding.| Healthcare Dive
Because of the final rates for next year, Humana will have to enact “larger benefit reductions to achieve stable margins,” its CFO told investors.| Healthcare Dive
The health insurer’s stock plunged Thursday morning following its 2023 results, which fell startlingly short of Wall Street’s expectations.| Healthcare Dive
The big question coming out of the health insurance earnings season is how much elevated utilization among seniors is carrying over into 2024.| Healthcare Dive