STAT

NOVEMBER 14, 2023

For more than a year, our reporters have documented how the use of artificial intelligence is driving denial of claims or delaying treatment for seriously ill patients. This latest story goes even deeper, establishing how the denial of claims was by design.

Health Insurance Companies 311

Health Insurance Companies Documentation 311

STAT

NOVEMBER 14, 2023

The nation’s largest health insurance company pressured its medical staff to cut off payments for seriously ill patients in lockstep with a computer algorithm’s calculations, denying rehabilitation care for older and disabled Americans as profits soared, a STAT investigation has found.

Health Insurance Companies 364

Health Insurance Companies Documentation 364

STAT

JANUARY 30, 2023

The federal government and health insurance companies have been clashing for more than a decade over how Medicare Advantage plans should be audited and how the well-documented overpayments to those plans should be clawed back.

Health Insurance Companies 288

Health Insurance Companies Documentation 288

pharmaphorum

JANUARY 27, 2023

While SaveOnSP is the nominal target of the lawsuit, it claims to expose one of the failings in the US health insurance sector, adding fire to an increasingly heated exchange between pharma manufacturers and pharmacy benefit managers (PBMs), which have blamed each other for high medicine prices in the US.

Health Insurance Companies 105

Health Insurance Companies Specialty Pharmacies Documentation 105

Viseven

JULY 11, 2023

The largest non-profit provider of behavioral healthcare in California used Salesforce Nonprofit Cloud to meet the increasing demand for mental health services and automate their workflow. Humana , a US-based health insurance company, took advantage of a few Salesforce products at once to build a single view around their customers.

Health and Personal Care Stores 40

Health and Personal Care Stores Insurance Coverage and Processing Scheduling Appointments Communication 40