Insurers prioritise modernisation, but struggle to implement

Insurers prioritise modernisation, but struggle to implement

Insurers have prioritised modernisation, but are struggling with implementation, according to a study from Earnix.

How Insurers Can Capture the Next Generation of Customers

To win in the future, insurers need to cater to an important new audience: millennials.

Medically Necessary

Health insurers have wide discretion in crafting what their policies cover, and they often deny claims for services they deem not “medically necessary.” An investigation by ProPublica and Capitol Forum revealed that Cigna, one of the largest health insurers in the country (and ProPublica’s insurance provider), built a system that allows its doctors to swiftly reject a claim on medical grounds without opening the patient file, leaving patients with unexpected bills. Using this method, one Cigna doctor single-handedly rejected 60,000 claims in a single month.

When UnitedHealthcare refused to pay for Christopher McNaughton’s treatment, his family did something rare: they fought back. The ensuing lawsuit uncovered a trove of internal documents that gave ProPublica a behind-the-scenes look at how United Healthcare relentlessly fights to reduce spending on care, even as profits rise to record levels.

At this event, reporters and insiders will explain how health insurance companies approach and process patient claims, and how this is influenced by their bottom lines. Experts will also discuss patients’ rights and potential fixes for America’s broken health insurance industry. Speakers include:
– T. Christian Miller, ProPublica senior editor (moderator)
– Dr. David Rubin, professor and chief of gastroenterology at the University of Chicago Medicine
– Maya Miller, ProPublica engagement reporter
– Mona Shah, senior director of policy and strategy at Community Catalyst
– Patrick Rucker, Capitol Forum reporter
– Ron Howrigon, former Cigna executive and current president of Fulcrum Strategies, a health care consulting firm specializing in payer contract negotiation

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Florida insurers face ratings change that could raise costs

A ratings agency has plans to downgrade more than two dozen Florida-based property insurance companies in a move that could cost more money for homeowners with loans.

The ratings firm Demotech plans to downgrade the 27 insurers from an “A” rating to ratings of either “S” for substantial or “M” for moderate, according to the South Florida Sun Sentinel.

Demotech rates 40 Florida-based insurance companies.

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Whistleblower insurance adjusters short clip 2

Attorney Steven Bush interviews whistleblowers from insurance companies after Hurricane Ian in southwest Florida.

The state of Florida made it a felony to misrepresent information on an estimate, will authorities prosecute the insurance companies and their vendors like they would the public?

A balance of power is needed to protect consumers after national disasters. Consumers have a right to hire their own representation, especially now that we know insurers are willfully denying the fair settlement of hurricane claims.

Insurers and policyholders should each have a right to hire their own adjuster to advocate for them, and in instances of fraud, each should be held criminally liable. Insurance companies play the victim card but this interview shows us that oftentimes law-abiding homeowners are victimized by the insurers and the people they employ.

TJ Ware, American Policyholder Association Board Advisor, and host of the Hurricane Ian Show discusses the potential implications of these bombshell allegations.

If you have been a victim of insurer fraud let the American Policyholder Association know at

Join the APA as an associate member today for free!

Subscribe to the Hurricane Ian Show, follow us on Facebook and TikTok and for additional information