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Topic: Payors

Detente between Payors and Providers?

Detente between Payors and Providers?

1. A Shift from Defensive Tech to Coordinated Infrastructure? Over the last several years, the relationship between payors and providers has at times resembled an AI-fueled arms race: * On one side, insurers deploy increasingly sophisticated algorithms to flag and deny claims based on pattern recognition and documentation gaps. * On the

AI-Driven Tension: Balancing Payor Budgets and Provider Needs in ABA Therapy

AI-Driven Tension: Balancing Payor Budgets and Provider Needs in ABA Therapy

Recently, Indiana proposed a significant policy change to its Medicaid program: capping Applied Behavior Analysis (ABA) therapy at 30 hours per week, with a maximum duration of three years. This move has sparked widespread concern in the ABA community, particularly because Indiana has historically been a strong supporter of ABA

Overcoming Barriers to Care: Insights into Autism Payor Challenges

Overcoming Barriers to Care: Insights into Autism Payor Challenges

This week, CNN and ProPublica published an article shedding light on the barriers families face in accessing autism therapy, focusing on insurers like UnitedHealthcare. Link: https://lnkd.in/gQs-CPb7 Having spent over a decade at UHG, I experienced both the privilege and responsibility of helping provide care to a significant