nH Predict is a computer program developed by naviHealth that implements an algorithm that has allegedly been used by health insurance companies including United Healthcare and Humana [1] [2] to automatically deny coverage to patients. [3] [4] [5] It is reported to work by cross-correlating patient health records with those of other patients. [6] The software allegedly has a 90% error rate. [7] [8]
It is estimated that such software automates away 50–75% of human labor that would be involved in such tasks. [9]
A class action lawsuit (Estate of Gene B. Lokken et al. v. UnitedHealth Group, Inc. et al.) was filed in November 2023 against UnitedHealth Group regarding use of this software. [10] [11] [12] UnitedHeath Group have stated that the lawsuit is unjustified. [11]
Aetna Inc. is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid insurance and benefit programs, and through Medicare. Since November 28, 2018, the company has been a subsidiary of CVS Health.
Health care, or healthcare, is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals and allied health fields. Medicine, dentistry, pharmacy, midwifery, nursing, optometry, audiology, psychology, occupational therapy, physical therapy, athletic training, and other health professions all constitute health care. The term includes work done in providing primary care, secondary care, tertiary care, and public health.
The Health Insurance Portability and Accountability Act of 1996 is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1996. It aimed to alter the transfer of healthcare information, stipulated the guidelines by which personally identifiable information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft, and addressed some limitations on healthcare insurance coverage. It generally prohibits healthcare providers and businesses called covered entities from disclosing protected information to anyone other than a patient and the patient's authorized representatives without their consent. The bill does not restrict patients from receiving information about themselves. Furthermore, it does not prohibit patients from voluntarily sharing their health information however they choose, nor does it require confidentiality where a patient discloses medical information to family members, friends or other individuals not employees of a covered entity.
Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.
The Cigna Group is an American multinational managed healthcare and insurance company based in Bloomfield, Connecticut. Its insurance subsidiaries are major providers of medical, dental, disability, life and accident insurance and related products and services, the majority of which are offered through employers and other groups. Cigna is incorporated in Delaware.
Ars Technica is a website covering news and opinions in technology, science, politics, and society, created by Ken Fisher and Jon Stokes in 1998. It publishes news, reviews, and guides on issues such as computer hardware and software, science, technology policy, and video games.
UnitedHealth Group Incorporated is an American multinational health insurance and services company based in Minnetonka, Minnesota. Selling insurance products under UnitedHealthcare, and health care services under the Optum brand, it is the world's ninth-largest company by revenue and the largest health care company by revenue. It is based on a market based health insurance system as opposed to universal health care.
In contract law, rescission is an equitable remedy which allows a contractual party to cancel the contract. Parties may rescind if they are the victims of a vitiating factor, such as misrepresentation, mistake, duress, or undue influence. Rescission is the unwinding of a transaction. This is done to bring the parties, as far as possible, back to the position in which they were before they entered into a contract.
Blue Cross Blue Shield Association, also known as BCBS, BCBSA, or The Blues, is a United States–based federation with 33 independent and locally operated BCBSA companies that provide health insurance in the United States to more than 115 million people as of 2022.
Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
Centene Corporation is a publicly traded managed care company based in St. Louis, Missouri, which is an intermediary for government-sponsored and privately insured healthcare programs. Centene ranked No. 25 on the 2023 Fortune 500.
Germany has a universal multi-payer health care system paid for by a combination of statutory health insurance and private health insurance.
Palantir Technologies Inc. is an American publicly traded company that specializes in software platforms for big data analytics. Headquartered in Denver, Colorado, it was founded by Peter Thiel, Stephen Cohen, Joe Lonsdale, and Alex Karp in 2003. The company's name is derived from The Lord of the Rings where the magical palantíri were "seeing-stones," described as indestructible balls of crystal used for communication and to see events in other parts of the world.
Elevance Health, Inc. is an American health insurance provider. Prior to June 2022, Elevance Health was named Anthem, Inc. The company's services include medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans through affiliated companies such as Anthem Blue Cross and Blue Shield, Anthem Blue Cross in California, Wellpoint, and Carelon. It is the largest for-profit managed health care company in the Blue Cross Blue Shield Association. As of 2022, the company had 46.8 million members within its affiliated companies' health plans.
A contraceptive mandate is a government regulation or law that requires health insurers, or employers that provide their employees with health insurance, to cover some contraceptive costs in their health insurance plans.
Cover Oregon was the health insurance marketplace for the U.S. state of Oregon, established as Oregon's implementation of the Patient Protection and Affordable Care Act. Cover Oregon was intended to enable Oregonians and small businesses to purchase health insurance at federally subsidized rates.
Artificial intelligence in healthcare is the application of artificial intelligence (AI) to analyze and understand complex medical and healthcare data. In some cases, it can exceed or augment human capabilities by providing better or faster ways to diagnose, treat, or prevent disease.
Optum, Inc. is an American healthcare company that provides technology services, pharmacy care services and various direct healthcare services.
Merative L.P., formerly IBM Watson Health, is an American medical technology company that provides products and services that help clients facilitate medical research, clinical research, real world evidence, and healthcare services, through the use of artificial intelligence, data analytics, cloud computing, and other advanced information technology. Merative is owned by Francisco Partners, an American private equity firm headquartered in San Francisco, California. In 2022, IBM divested and spun-off their Watson Health division into Merative. As of 2023, it remains a standalone company headquartered in Ann Arbor with innovation centers in Ireland, Hyderabad, Bengaluru, and Chennai.
Brian Thompson, the 50-year-old CEO of the American health insurance company UnitedHealthcare, was shot and killed in Manhattan, New York, on December 4, 2024. The shooting occurred early in the morning outside an entrance to the New York Hilton Midtown hotel. Thompson was in the city to attend an annual investors' meeting for UnitedHealth Group, the parent company of UnitedHealthcare. Prior to his death, he faced criticism for the company's rejection of insurance claims, and his family reported that he had received death threats in the past. The suspect, initially described as a white man wearing a mask, fled the scene. On December 9, 2024, authorities arrested 26-year-old Luigi Mangione in Altoona, Pennsylvania and charged him with Thompson's murder in a Manhattan court.