Legislators in different U.S. states are clamping down on health insurance companies’ use of artificial intelligence (AI).
New rules focus on preventing AI being used to screen patient’s claims and issue denials, Axios reported.
Why It Matters
Health insurance firms have been under scrutiny in recent weeks after the assassination of United Healthcare CEO Brian Thompson, with some accusing companies of treating customers unfairly. The enforcement of new rules suggests that lawmakers are willing to take a stand on behalf of their constituents to address some of the issues.
What To Know
Last week, California implemented the Physicians Make Decisions Act to ensure that decisions about medical treatments are made by licensed health care providers and not solely by AI algorithms used by health insurers.
While AI can improve efficiency, the use of the software to handle patient claims can raise concerns about inaccuracies and bias in health care decision making, according to the Becker’s website.
California state Senator Josh Becker told Newsweek, “The U.S. spends more on health care than any other nation, yet we achieve mediocre outcomes.”
“Shockingly, 33 cents of every dollar spent on healthcare goes to administrative costs rather than direct care—a staggering inefficiency that drains resources and frustrates patients and providers alike,” he added.
Becker said this means “many Americans struggle with denied claims or inadequate coverage for necessary treatments, creating financial hardships and sometimes even forcing them to forego care entirely.”
“We must change the health care system so that it prioritizes patients over profits.”
Legislation in Georgia, New York and Pennsylvania could require health insurance companies to disclose to patients and health care providers when they have used AI in the handling of a claim, Bloomberg Law reported. Pennsylvania would also require state-regulated health plans to provide information on the AI tools they use in their utilization review process to the state Department of Insurance.
Per the outlet, in Oklahoma, legislation could require insurers to publicly disclose the use of AI and also for them to submit the algorithms and training data sets to the Oklahoma Insurance Department.
In New Jersey, state-regulated health insurance companies will also have to decide more promptly if they will cover a test or treatment recommended by a patient’s doctor, according to Axios. The time frame they will have to decide is within 24 to 72 hours.
In Illinois, there have been a vast number of reforms in legislation for health insurance companies, for example that health insurance must cover annual prostate cancer screenings, cervical smears or Pap smears for all insured individuals, regardless of gender, according to NBC Chicago.
Per the outlet, one new rule also states that health insurance companies must provide coverage for mental health therapy services to police officers, those in fire protection and any spouse or partner of members in those fields.
What People Are Saying
Becker, in a statement to Newsweek: “Our health care system is riddled with systemic issues that prevent patients from receiving the care they deserve. No other industrialized country’s health care system operates like ours. We can’t have a system that routinely delays or denies necessary care. Patients often face hurdles like endless prior authorizations, surprise billing, and restrictive networks, which disrupt their access to timely and necessary treatment. Stronger regulations are essential to ensure health care decisions are made by physicians in consultation with their patients—not dictated by insurance company policies driven by profit.”
New York Assemblymember and Vice President of the National Council of Insurance Legislators Pamela Hunter told Bloomberg Law: “These are essentially tools used to make life-changing, altering decisions for people. We can’t wait—consumers need to be protected now.”
What’s Next
According to Bloomberg Law, insurance groups have previously argued the state proposals can go too far in regulating their decision making, but the issue is starting to reach the federal level as well.
Update 01/08/25, 02:46 a.m. ET: This article has been updated with comment from California state Senator Josh Becker.
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