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‘AI arms race’ underway as payers, providers jockey for upper hand in claims review

‘AI arms race’ underway as payers, providers jockey for upper hand in claims review

Payers currently have a leg up when using AI to review claims, but providers could soon catch up, experts say....

UnitedHealth, CVS push to remove FTC Chair Lina Khan from PBM case

UnitedHealth, CVS push to remove FTC Chair Lina Khan from PBM case

Attorneys argue Khan and two other commissioners are biased against pharmacy benefit managers and should recuse themselves from an ongoing lawsuit...

Humana’s Medicare Advantage dilemma worsens amid precipitous drop in 2025 star ratings

Humana’s Medicare Advantage dilemma worsens amid precipitous drop in 2025 star ratings

Only 25% of Humana members will be in plans with four stars or above next year, down from 94% this...

US is drastically behind other wealthy nations on healthcare, despite spending the most

US is drastically behind other wealthy nations on healthcare, despite spending the most

The Commonwealth Fund analyzed the healthcare systems of 10 nations and found the U.S. ranked last in access to care,...

Fertility benefits are on the rise: report

Fertility benefits are on the rise: report

More employers now offer fertility benefits, particularly fertility medications and in vitro fertilization, according to a new report. Article By:...

Biden administration finalizes rule raising mental health coverage standards for private plans

Biden administration finalizes rule raising mental health coverage standards for private plans

The rule gives additional teeth to an almost 16-year-old law meant to force health insurers to cover mental health and...

Medicare Advantage prior authorization denials increased in 2022

Medicare Advantage prior authorization denials increased in 2022

More than 80% of denied requests were overturned when appealed, but few beneficiaries formally questioned the decisions. Article By: Emily...

Premiums for ACA plans to grow 7% next year: KFF

Premiums for ACA plans to grow 7% next year: KFF

Insurers cited workforce shortages, hospital consolidation and growing demand for pricey GLP-1 drugs as reasons driving the premium increases for 2025....

Appeals court hands providers latest win in No Surprises litigation

Appeals court hands providers latest win in No Surprises litigation

The 5th Circuit Court’s decision vacates instructions that arbiters should first consider the qualifying payment amount in deciding payments over contested out-of-network bills. Article...

Cardiovascular conditions now the second-highest reimbursement category, Sun Life says

Cardiovascular conditions now the second-highest reimbursement category, Sun Life says

Cost of cardiovascular conditions is up 33% — “higher than we would expect given medical inflation,” the company said. Article...