Automation Impact in Claims Processing

Praveen Kumar Rawat

Abstract:- – Better care at a cheaper price is not the result of more options. Large and small businesses in the United States are increasingly offering lower-priced, more flexible high-deductible plans with more options for narrow networks and greater out-of-pocket payments. Workers who are older and sicker would be more likely to enrol in conventional plans and pay higher premiums if the research shows that these are more appealing to younger, healthier consumers (Lave et al., 2011). On the other hand, switching to high deductible plans does make consumers more conscious of the expense of care and makes them think twice before getting treatment. On the other hand, this will cut down on both essential and superfluous medical treatment. When a loved one is ill or injured, people aren’t exactly clamouring for the “choice” to shop around for the cheapest price, even if cost awareness and more information are good things. The availability of alternatives to workers is ultimately decided by the employers. It would seem that the current variety of health plan alternatives does nothing to encourage maximum efficiency or customer happiness.Managed competition using standardised plans and customer data was a key component of the Affordable Care Act’s marketplaces’ design to promote efficiency. Whether or whether this will be successful is unknown. Although premium pricing have changed and marketplaces have drawn insurers, many of the essential components for a sustainable marketplace are still missing. There can be no fair comparisons as the federally-organized marketplace in Texas does not standardise plans, even when comparing plans in the same tier with respect to cost-sharing discrepancies. Although there is greater uniformity and it is simpler to compare in Massachusetts, the sheer volume of options is still overwhelming. In addition, data from California and other market exchanges suggests that customers tend to remain with the plan they are familiar with after the first pick, even when there are optimisation options. Still, the ACA’s subsidies and coverage expansion provide the uninsured a lot more alternatives.

DOI: /10.61463/ijset.vol.9.issue3.110