New Arizona law prevents AI from making health insurance denials

PHOENIX (AZFamily) — Artificial intelligence won’t have the final say in your health care.

On Wednesday, Gov. Katie Hobbs held a private signing ceremony for a new state law that will require a person to oversee medical insurance denials.

“Governor Hobbs was proud to sign HB 2175, which will require healthcare claims denied on the basis of medical necessity to be reviewed by a licensed professional. When Arizona doctors and health professionals prescribe specific treatment for their patients, insurance companies should cover them, not stand in the way,” her office told Arizona’s Family.

The new law, HB 2175, does not explicitly mention artificial intelligence, but it does require a medical director to review denials.

“The medical director shall exercise independent medical judgment and may not rely solely on recommendations from any other source,” the law reads in part.

AI’s role in medical insurance has become an increasing concern among doctors. A recent survey by the American Medical Association shows 61% of physicians are concerned that health plans’ use of AI is increasing prior authorization denials and ‘exacerbating avoidable patient harm.’

“When it is in patient care, something that may delay people getting life prolonging or lifesaving tests or treatments, we need to still have that human touch, because not everything fits into an algorithm,” said Dr. Sarah Lee-Davisson, a physician leader with the Arizona Medical Association, which championed the new law.

“I have plenty of doctors who say, ‘For sure. This was a no-brainer. This should have gotten done for this patient,’ and it’s just a ridiculous burden on us and the patient to have it delayed because now we just have to fight it.”

The new law, which Hobbs officially signed last month, goes into effect at the end of June. There was only one ‘no’ vote in the state’s House of Representatives.

AHIP, which represents the medical insurance industry, said it does not have a comment on Arizona’s new law.

“Health plans are leading the way to further improve this vital patient protection tool, and we welcome the opportunity to work with policymakers to ensure patients receive safe, evidence-based care while reducing low-value and inappropriate services so that coverage is as affordable as possible,” a spokesperson for the organization wrote in a statement about the issue of prior authorization.

If you have a claim or prior authorization that’s denied, whether by AI or a human, you can appeal it. First, ask for the reason it was denied. File an appeal directly with your insurance company. If you hit a roadblock, you can also file an appeal through the Arizona Department of Insurance and Financial Institutions. It’s important to gather as much information as you can. Your doctor can be helpful with this.

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