Live Insurance News

Can AI Really Decide Your Medical Needs? Texas Says Not Alone

January 28, 2025January 27, 2025 Ben Jones

Texas Senator Pushes for Stricter AI Regulations in Health Insurance Claims AI in Health Insurance: A Double-Edged Sword The health insurance industry is increasingly turning to artificial intelligence (AI) to streamline processes like patient claims. AI promises faster results, reduced administrative costs, and fewer delays. However, as Texas lawmaker Senator Charles Schwertner highlights with his recently proposed legislation, this growing reliance on AI also comes with serious risks—especially when AI systems replace human expertise in critical medical decisions. Schwertner introduced a bill on January 16 that aims to limit the…

Tragedy, Reform, and the State of Health Care – A Look at UnitedHealth Group

January 23, 2025January 22, 2025 Marc

A Shocking Loss That Shook a Nation The murder of Brian Thompson, the CEO of UnitedHealth Group’s UnitedHealthcare division, stunned the country in December 2024. Thompson, a 50-year-old husband and father of two, was fatally shot while walking to a company meeting in New York City. It was a crime that not only horrified his colleagues and family but also put a harsh spotlight on the broader frustrations with the U.S. health care industry. The accused, Luigi Mangione, reportedly had grievances about systemic issues in the health care system. He…

Massive $21 Billion Medicare Boost Set to Transform Senior Healthcare in 2026

January 14, 2025January 13, 2025 Logan B.

Proposed 2026 Medicare Advantage Reimbursement Rates See Positive Growth The Centers for Medicare & Medicaid Services (CMS) has proposed a 2.2% increase in reimbursement rates for Medicare Advantage (MA) plans in 2026, marking a sharp improvement from the 0.2% decline seen the previous year. When factoring in the 2.1% “risk score” adjustment to account for higher payments for individuals with severe health conditions, the total estimated increase in payments rises to 4.3%—equivalent to more than $21 billion. This proposal is poised to have a significant impact on insurers, healthcare beneficiaries,…

California Health Insurance Law SB 1120 Takes a Stand Against AI-Driven Health Insurance Denials

January 11, 2025January 10, 2025 Angela Linders

California Enacts SB 1120 to Rein in AI-Powered Health Insurance Decisions California has taken a groundbreaking step in regulating the role of artificial intelligence (AI) in health insurance decision-making. Senate Bill 1120 (SB 1120), also known as the “Physicians Make Decisions Act,” prohibits health insurers from denying, delaying, or altering claims solely based on AI algorithms. Signed into law by Governor Gavin Newsom, this legislation ensures human oversight in healthcare coverage decisions, addressing mounting public concerns about fairness and accuracy in the use of AI technologies. Effective as of January…

Massachusetts Court Orders UnitedHealthcare Affiliates to Refund Millions to Victims

January 10, 2025January 10, 2025 Logan B.

Massachusetts Court orders Unitedhealthcare refund

UnitedHealthcare-Affiliated Insurers Ordered to Pay $165 Million for Misleading Consumers Historic Ruling Against Deceptive Sales Practices A Massachusetts Superior Court has ordered HealthMarkets Inc. and its subsidiaries, The Chesapeake Life Insurance Company and HealthMarkets Insurance Agency, to pay $165 million for engaging in what the court described as “egregious” and widespread deceptive practices. These companies, owned by UnitedHealth Group, have been found guilty of misleading thousands of Massachusetts consumers into purchasing supplemental health insurance policies they did not need or fully understand they were buying. This judgment—comprising $50 million in…

Affordable Care Act Enrollment Breaks Records But Faces an Uncertain Political Future

January 10, 2025January 10, 2025 Live Insurance News

Record ACA Enrollment Under Biden Administration The Biden administration has announced a groundbreaking achievement in health care access, with nearly 24 million Americans enrolling in Affordable Care Act (ACA) Marketplace plans for 2025. This record-breaking figure nearly doubles the enrollment totals from four years ago, solidifying the ACA as a critical pillar of American health care. The success is attributed to expanded federal subsidies, streamlined enrollment processes, and heightened outreach efforts under President Joe Biden’s leadership. The Role of Enhanced Federal ACA Subsidies A significant driver behind the surge in…

From Repeal to Rescue: Why Republicans Are Backing Affordable Care Act Subsidy Extensions

January 6, 2025January 5, 2025 Live Insurance News

Republicans Warming to ACA Subsidies Amid Healthcare Challenges A recent Forbes article has brought attention to a growing shift among Republican lawmakers regarding their stance on extending health insurance subsidies under the Affordable Care Act (ACA). Commonly known as Obamacare, the ACA has long been polarizing, but this change signals a recognition of the program’s widespread impact. The subsidies, expanded under the Inflation Reduction Act (IRA) of 2022, have played a crucial role in making healthcare more affordable for millions of Americans. With these provisions set to expire at the…