UHC Robs Peter To Pay Paul, Outsourcing To AI, & CRISPR’s Inflection Point

Hey all,

I hope you had a great holiday weekend. I was lucky enough to spend some time poolside, recovering from the chaos of switching insulin pumps. UnitedHealth seems more concerned with their margins than my blood sugar — as long as I don’t end up in the ER, they’re content. 

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Modern Healthcare) Claim Denials vs. Prior Authorization in 2024

Health insurers initially denied 11.8% of hospital-based claim dollars in 2024—up from 11.53% in 2023—even as prior authorization-related rejections fell slightly, according to Kodiak Solutions. The shift suggests denials are increasingly based on other factors like medical necessity or missing records, raising concerns about administrative complexity despite insurers ultimately paying nearly 97% of requested amounts. Turns out, it’s easy to cut down on prior auth denials—just deny the claim later instead. Full Article

(KFF Health News) AI Disrupting Call Center Healthcare Jobs

AI is rapidly advancing into healthcare call centers, threatening the jobs of over 200,000 workers in the Philippines by automating tasks like scheduling, triaging, and even managing patient interactions. While companies cite efficiency, lower costs, and improved patient satisfaction as reasons for adopting AI, critics highlight concerns over losing the human touch essential in healthcare, AI’s inability to fully understand patient context, and the psychological toll on remaining workers. And sure, AI might fumble your question—but so can a half-asleep call center nurse on the 3 a.m. shift. Full Article.

(STAT News) What Baby KJ Means for the CRISPR Gene Editing Industry

The experimental CRISPR-based treatment that allowed infant KJ Muldoon to avoid a liver transplant represents a stunning medical feat—and a pivotal moment for a struggling gene editing field. While KJ’s case renews optimism in the potential of customized gene therapies, experts warn that the approach remains prohibitively expensive, not scalable, and largely limited to liver diseases, casting doubt on its broader feasibility. Nevertheless, innovations in gene editing predictability, manufacturing, and regulatory models—like “process approvals” and genetic surgery frameworks—could one day transform this bespoke science into a replicable treatment strategy. Full Article