It has become all too common: A healthcare system and an insurance company approach the expiration date for their contract and become embroiled in a nasty dispute.
Letters from each blaming the other side are sent to patients covered by the insurance company, warning that their physicians may end up out of network if a new contract is not reached before the expiration deadline.
Health insurance companies are under increasing scrutiny for allegedly using artificial intelligence bots and algorithms to swiftly deny patients routine or lifesaving care — without a human actually reviewing their claims.
Amid its climb toward financial stability, Delta Health Hospital lost its footing after a string of unexpected expenses and complications, from Medicaid “clawbacks” to the loss of millions in drug discounts.
That stumble left the hospital with only a few days of on-hand cash; however, Delta Health executives emphasized the hospital is not in peril of closing.
A recent appeals-court ruling restricts options for hospitals seeking to use litigation to ensure prompt Medicaid payment.
The March 14 ruling by the U.S. Court of Appeals for the Seventh Circuit in Saint Anthony Hospital v. Whitehorn essentially states that hospitals do not have a legal right to sue state Medicaid programs under federal law to obtain timely payment.
In the wake of the boom of artificial intelligence (AI), more healthcare insurance companies are using the technology to speed up the process of evaluating patient medical claims, making it quite likely AI played a hand in determining the outcome of your payout.