How AI is simplifying health insurance for seniors

The AI Paradox in Healthcare: Denials and Solutions Did you know that doctors are reporting an increase in health insurance denials, and they're pointing to AI as the culprit? It's a shocking irony, given AI's potential to revolutionize healthcare. But some forward-thinking healthcare providers are fighting back – by leveraging AI to combat these denials. Here's the catch: AI-powered systems are often used to streamline claims processing, but they can also lead to errors, misinterpretations, and unjust denials. However, AI can also be used to identify and challenge these denials, ensuring patients receive the care they need. What can we do about it? 1. **Embrace transparency**: Healthcare providers must be open about their use of AI in claims processing, ensuring accountability and fairness. 2. **Leverage AI for appeals**: By using AI to identify and challenge denials, healthcare providers can improve patient outcomes and reduce administrative burdens. 3. **Invest in human oversight**: Combining AI with human expertise can help reduce errors and ensure that denials are justifiable. Let's work together to harness the power of AI for good in healthcare. Share your thoughts: How can we balance the benefits of AI with the need for human oversight and transparency? #AIinHealthcare #HealthInsurance #MedicalBilling #HealthcareInnovation #PatientCare

✅ Colorado’s 2025 Special Session has officially adjourned sine die. CAHP was actively engaged throughout this extraordinary session to ensure that critical issues impacting health coverage were addressed responsibly: • Health Insurance Affordability Enterprise (HIAE) – Lawmakers advanced HB25B-1006, which strengthens the state’s ability to improve affordability in the individual market while ensuring funding stability. • Artificial Intelligence (AI) – After much debate, proposals were narrowed significantly. The legislature ultimately decided to delay implementation of Colorado’s prior AI law until June 2026, giving stakeholders more time to prepare and collaborate. CAHP will continue working with policymakers, regulators, and partners to make health insurance more affordable and to shape smart, workable AI policies for Colorado. #COleg #healthinsurance #affordability #AI #cogov

Big news in healthcare tech! #HealthProof, #HealthEdge, #M&A. HealthProof has moved out of UST and is now part of HealthEdge, backed by Bain Capital. This is a strong step forward. Together, they will offer faster, smarter, AI based automation solutions to health insurance companies. Right now, both teams serve 100+ customers, reaching over 100 million lives. Under the HealthEdge brand, HealthProof is ready to scale, innovate, and help deliver better care. https://lnkd.in/gFSp6D_B

Recent research by Data Axle #PoweredbyDynata reveals there’s growing demand for personalization across health insurance but also clear expectations about how it’s done. Key takeaways: 📌 Personalization is now expected across benefits, coverage and communications. 📌 Trust and consent are crucial. Consumers are willing to share certain types of health, lifestyle or behavior data, but only if they understand the benefit, know what will be done with it and have control. 📌 There are generational differences. Younger cohorts tend to be more digitally comfortable, more open to data sharing and embrace AI/automation more readily. Older cohorts tend to want simplicity, control, clarity, and consistency. 📌 AI is seen as both promising and risky. It’s welcomed for its potential to improve recommendations and experience, but people want transparency, human oversight, and opt-out options. Consumers want technology that works for them, not on them. For insurers, the opportunity lies in getting personalization right – not just as a tech upgrade, but as a trust-building strategy. #insurance #healthinsurance #healthdata

Aarogya Setu 2.0 is coming. PM Modi to launch an AI-powered health app unifying medical records, teleconsultations, insurance & more under one digital platform — making quality healthcare simpler, seamless & citizen-first. Read here : https://lnkd.in/d8ymCfCm #DigitalHealth #ABDM #AarogyaSetu #AI #ML

The National Committee on Quality Assurance (NCQA) has launched an artificial intelligence working group to determine how to best measure performance of high-risk AI once it has been deployed by health plans and providers. The NCQA has convened more than 30 organizations to share their experiences using AI and help create standards for the technology. Some members of its AI working group are the American Academy of Family Physicians, America's Health Insurance Plans, Blue Cross Blue Shield of Tennessee, the Community Care Plan, Covered California, the Kaiser Foundation Health Plan and United HealthCare.

Premiums climb. Profits sore. Patients lose. Health care costs are rising…no one disputes that. But while families face five-figure premiums/OOP expenses and cut back on routine care, national carriers report billions in profits. How? By leaning on AI algorithms, downcoding, and prior authorization processes designed to frustrate physicians into giving up. The result? Insurance that barely covers prevention, only catastrophe. Patients delay care, chronic conditions worsen, and costs keep climbing. If “health insurance” no longer protects health, then what are we really paying for? https://archive.ph/9abMQ #HealthCareReform #InsuranceProfits #ProfitsOverPatients

“Denial is not a strategy in 2025.” That’s the message from SCAN Group’s CEO, Dr. Sachin Jain, as the nonprofit insurer launched a national campaign openly calling health insurance broken. What makes this bold? • It’s rare to see an insurer put the industry’s flaws in the spotlight. • Older adults are frustrated with delays, denials, and complex processes—SCAN is saying what many feel. • Other leaders, from Elevance Health and Aetna, have weighed in—agreeing it’s good to name the problems but pushing for scalable solutions. This raises the bigger question: Is calling out the system enough, or do we need a roadmap for real change? I see value in both—naming what’s broken and building the operational infrastructure to fix it. Denial won’t move us forward, but transparency might. What do you think—can bold honesty from payers spark real healthcare reform, or will it take more?

"Insurance claim denials are a silent epidemic—but what if the same AI that refuses care could now help you fight back? This new RTP-based startup, Counterforce Health, is using AI to draft appeals in minutes—free for patients and clinics, and even deployed via mobile clinics in rural NC. With reversal rates around 70%, this is the kind of innovation that could transform healthcare access. Curious how it works and what’s next for AI in insurance? Check it out."** #aiinsurance #ai #insurance

What happens when AI-powered technology joins hands with empathetic care? You get a new era of health insurance support that’s smarter, faster, and more human. In her latest blog, Dr. Smrite Goudhaman shares how insurers can reimagine customer support with the right blend of tech and compassion. 👉 Read now: https://lnkd.in/daU_-vFx #HealthInsurance #AI #CustomerExperience #DigitalInnovation #Datamatics