You can thank uninformed people on social media for this – along with uniformed politicians, of course.
Take care of fraud, abuses, not abiding by contract or plan provisions, but this broad brush approach is naive and stupid.
This will lead to higher costs, higher premiums and increased fraud and abuse!
I can tell you from decades of experience managing health benefits and resolving claim appeals that many (most) of the horror stories are inaccurate, incomplete or false. To many people if a claim is not pay in full, no questions asked, it’s abuse by the insurance company. People want a blank check … as long as someone else pays the bill.
Mounting public anger over health insurance is leading more state legislatures to eye tighter oversight of the industry, starting with its use of AI to screen claims and issue denials.
The big picture: Even before Thompson’s killing revealed widespread anger over insurer decisions, states were targeting prior authorization and other tools health plans use to manage health care use, with more than 90 different bills proposed nationwide last year, according to Georgetown University’s Center on Health Insurance Reforms.
- “States were already primed to scrutinize insurers more closely,” Larry Levitt, executive vice president for health policy at KFF, told Axios. “The backlash in the aftermath of the killing of Brian Thompson will likely only accelerate state action.”
- The calls for action are being amplified by physicians and other longtime insurer antagonists.
- “With both sort of pressures pushing on [state] legislators to take some action, I do think we’re likely to see more bills advance in the 2025 legislative session,” said Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms.
Zoom in: California last week began prohibiting the use of AI for coverage denials, and lawmakers in Georgia, New York and Pennsylvania are vowing to bring up the issue this year, Bloomberg Law reports.
- In New Jersey, state-regulated health insurance companies will have to decide more quickly — within 24 hours and 72 hours — whether they will cover a test or treatment recommended by a patient’s doctor.
- A slew of health insurance reforms took effect at the start of the year in Illinois, including a ban on “step therapy,” where patients have to use cheaper drugs before being approved for more expensive ones.
Source: More states crank up oversight of health insurers, Axios
QUINNSCOMMENTARY 
Quinn, I think this is an example of the problem with insurance. There are people who will seek to profit by it because the money is there. That is the fraud angle. That includes people in the industry and people outside it. Then there are insurers themselves who see the profit angle as something to be maximized. Add in the customers with an unpaid bill and the providers who chafe under requirements that they think are unfair and one sided. It’s a marvel the set up works at all.
Look at how many people are in this country, how many insurance providers there are and how many healthcare providers there are. It’s a legislatures dream.
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I’m tired of hearing that the problem with insurance is the uneducated insureds and social media. It took a CEO shooting for Anthem to decide that maybe they will pay for all of your anesthesia after all, it is clear that they know their policies are hurtful. When your doctor is telling you need something and the insurance company says no, what are we to do, how are we to react? PSEG no longer has the type of folks like you and Charlie from Audubon who would dive in and fix a problem on our behalf. We’re left alone with very little mechanism to fight but we keep making those payments. Insurance companies (and benefits managers) should do a deep dive and figure out why they are despised
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