|August 14, 2023 07:29 AM
|Representative Arvind Venkat and Rep. Joe Hogan, Rep. Tarik Khan, Rep. Bridget M. Kosierowski, Rep. Robert W. Mercuri, Rep. Nick Pisciottano
|All House members
|Regulation of Artificial Intelligence (AI) Use in Health Insurance Claims Processes
|Artificial Intelligence (AI) represents the next frontier in technological advancement, with the potential to both aid and harm multiple areas in our economy. One area of particular need for regulation is the use of AI in health insurance. In 2022, it was revealed that, in only two months, Cigna denied more than 300,000 claims during a review process that relied upon computer algorithms for primary evaluation and that Cigna-employed medical professionals with a responsibility for claims reviews only spent roughly 1.2 seconds on each case, depending on the computer assessment to have done the in-depth review that should be performed and is mandated to require an individualized medical assessment (https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims). This short amount of time examining health insurance claims and rapid denials can leave individuals with unexpected and unpaid bills for medically necessary treatment. AI has the potential to only worsen this concern without appropriate regulation.
As AI is rapidly implemented by health insurers in their utilization review process, it is important for all Pennsylvanians, and especially patients and health care providers, to know what methods are being used to approve or deny their claims and that we place guardrails on the use of this technology in this sensitive area. For this reason, we will shortly be introducing legislation that would require health insurers to:
Please join us in this effort to improve the health insurance utilization review process to protect consumers and appropriately regulate the use of AI-based algorithms by health insurers.
Introduced as HB1663