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Humana is 2nd insurer to face lawsuit for AI-based denials of Medicare Advantage claims

By Alan Goforth

One of the nation's largest health insurance providers was using the same AI tool, nH Predict – with an alleged 90% error rate that overrides medical judgment – that UnitedHealthcare was sued for in November.

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Optum Rx, UnitedHealth's PBM, sued by independent pharmacy over backdoor fees

What employers are saying about ICHRAs

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Consumer Driven Health Care Stories

December 27, 2023

The 9 most influential FDA-approved drugs and vaccines of 2023

The list, which highlights first-in-class medications and vaccines, represents "meaningful steps forward" when it comes to weight loss, Alzheimer's, birth control and postpartum depression, as selected by GoodRx pharmacists.

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December 27, 2023

Bad medicine? When asked about prescriptions, ChatGPT mostly got it wrong

The popular AI tool's answers to most drug-related questions were incomplete or wrong in a new study, cautioning health care professionals about using ChatGPT as an "authoritative source for medication-related information."

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December 27, 2023

Green lighting: the path to smarter prior authorization

A data-driven alternative called "green lighting" has emerged as a more efficient and flexible approach to prior authorization.

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December 26, 2023

Dangerous doctors? Malpractice-prone docs, hired by insurers, are 'cranking out denials'

At least a dozen doctors were hired by major insurance companies after being disciplined by state medical boards or making multiple or outsized malpractice payments, according to a ProPublica and Capitol Forum investigation.

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December 26, 2023

3 things to know about specialty pharmacy in 2024

Specialty drug costs keep going up for plan sponsors Here are a few considerations employers and their brokers and consultants need to take into account in the coming years.

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December 22, 2023

Why did a quick virtual urgent care visit cost a patient $660?

Providers are supposed to inform patients when the care being rendered is out of network, but that "informed consent" is often buried in a pile of consent forms that patients auto-sign, in rapid fire.

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December 21, 2023

Employers looking to drive engagement by consolidating benefits, adding virtual specialty care

Although 86% are satisfied with their current health and medical benefit offerings, they are inundated with the management of 49 or more narrowly focused, condition-specific point solutions.

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Consumer Driven Health Care

Top Consumer Driven Health Care Stories

Humana is 2nd insurer to face lawsuit for AI-based denials of Medicare Advantage claims

Optum Rx, UnitedHealth's PBM, sued by independent pharmacy over backdoor fees

What employers are saying about ICHRAs

Recommended Just For You

Consumer Driven Health Care Stories

The 9 most influential FDA-approved drugs and vaccines of 2023

Bad medicine? When asked about prescriptions, ChatGPT mostly got it wrong

Green lighting: the path to smarter prior authorization

Dangerous doctors? Malpractice-prone docs, hired by insurers, are 'cranking out denials'

3 things to know about specialty pharmacy in 2024

Why did a quick virtual urgent care visit cost a patient $660?

Employers looking to drive engagement by consolidating benefits, adding virtual specialty care