David Talby’s Post

California Law Blocks Health Insurers From Denying Claims Through AI California's new law mandating human oversight in health insurance decisions marks a critical step forward. The law ensures AI algorithms can't unilaterally deny coverage, protecting the doctor-patient relationship while embracing technological innovation. #HealthcarePolicy #AI #HealthInsurance #CaliforniaLaw #HealthcareTech https://lnkd.in/g5XwGncm

2024 is proving to be another big year for the proponents of psychedelic-assisted therapy. As various states law moves towards legalization while the FDA considers approving multiple psychedelic substance applications, patients and providers alike are wondering about insurance coverage for these treatments. My colleagues, Kimberly Chew, Jameson Sauseda, Natasha Sumner, and I wonder about these things too... Thank you to Law360 for publishing our article "3 Health Insurance Paths for Psychedelic-Assisted Therapy" on how state insurance mandates, DEA rescheduling, and evolutions in the standard of care may affect health plan coverage for these emerging therapies. https://lnkd.in/gvJT8er6

🚨 REMINDER 🚨 Gag Clause Attestations are due at the end of this month! The annual Gag Clause Prohibition Compliance Attestation (GCPCA) is a new requirement from the Consolidated Appropriations Act (CAA) that prohibits group health plans and health insurance issuers offering group health coverage from entering into an agreement with a provider or TPA that would restrict the plan from providing cost or care information to plan participants, accessing de-identified claims data, and sharing information per privacy regulations with a business associate. Learn more on the News page!

Demand for transparency intensifies as unanswered questions around NHI Act persist - The passage of the National Health Insurance (NHI) Bill into an Act of law has set the stage for one of the most significant overhauls of South Africa’s healthcare system. - https://lnkd.in/dkZb-kY3 #constitutionalrights #healthcarechallenges #healthcaresystem #medicalschemes #nhibill Health Funders Association (HFA)

Employers with insured group health plans may soon receive a medical loss ratio (MLR) rebate from their health insurance issuers. Issuers who did not meet the applicable MLR percentage for 2023 must provide rebates to plan sponsors by Sept. 30, 2024. This Legal Update summarizes the legal rules for MLR rebates.

HR639 is one to watch "To prohibit group health plans, health insurance issuers, and Federal health care programs from applying prior authorization requirements, utilization management techniques, and medical necessity reviews" Simple and too the point https://lnkd.in/eE-8JgMM

In early 2024, the U.S. Department of Health and Human Services (HHS) issued a final rule amending the regulations in 42 C.F.R. part 2 which governs the confidentiality and privacy of substance use disorder (SUD) records. The amendments aim to bring Part 2 regulations more in line with the rules under the Health Insurance Portability and Accountability Act, which governs the use and disclosure of protected health information. #SGRLaw #HHS #HIPAA Read more in our latest #LegalAlert authored by Susan Atkinson and Carson M. Lamb at: https://lnkd.in/eaHsTUMr

You know what I love? When I do an insurance appeal for a client and we win! It's so satisfying to get a BCBS denial overturned. Of course, what we all really need is for the health insurers to do what's right in the first place and cover medically necessary services that members are entitled to. I'd also like to see legislation where the health insurer has to pay my fee. Why should my clients have to pay me in order to get what they are rightfully due! #patientadvocacy #insuranceappeals InTune Health Advocates LLC