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PCMA unanimous Supreme Court decision in 2020, which allowed states to regulate PBMs, the big healthinsurancecompanies and their PBM lobby have been barnstorming the country putting up one legal challenge after another.
Inside the nation’s largest healthinsurancecompanies, artificial intelligence is taking off like a rocket. Elevance, which covers about 110 million people, has rolled out a generative AI model to 50,000 employees.
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Oscar Health has excelled at one thing in particular since its inception a decade ago: burning cash. The healthinsurancecompany did not plan to be profitable immediately. It was staking its future on the new Affordable Care Act marketplaces and had to grow quickly to compete with larger insurance carriers.
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Patients are waiting, but I’d be unwise to put off the caller: a physician calling from a healthinsurancecompany. This peer-to-peer call is part of the prior authorization process; my “peer” needs information to determine whether the company will cover a procedure I requested for one of my patients.
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