Sen. Mike Tipping introduces bill to protect Maine patients from automatic denials of health insurance claims by AI

AUGUSTA – On Tuesday, April 8, Sen. Mike Tipping, D-Orono, introduced a bill to protect Maine patients from automatic denials of health insurance claims by artificial intelligence (AI). The Legislature’s Health Coverage, Insurance and Financial Services Committee conducted a public hearing for LD 1301, “An Act to Prohibit the Use of Artificial Intelligence in the Denial of Health Insurance Claims.” 

“We’ve all heard stories of health claims being denied, and we all know the cost in human suffering that these denials often incur,” said Sen. Tipping. “This bill takes two important steps to protect Maine patients and regulate the practices of insurance companies. It requires that carriers only use AI in a way that considers a patient’s medical history, and it also requires that a human being —not a computer — decide any denial of health care services. By standing up for Maine patients and health care providers we can make health care a little more human and put these basic protections into place.”

As introduced, LD 1301 would require that carriers only use AI, algorithms and other software in a way that takes patients’ medical history and individual circumstances into account. It would prohibit discrimination against patients based on their personal characteristics. Use of AI would be disclosed and the software be open to inspection.

Second, it would require that any denial, delay, modification or adjustment of health care services be made by a human being, not a computer. Specifically, it would be made by a “clinical peer competent to evaluate the specific clinical issues involved in the health care services requested.”

This policy is in line with protections put in place by other states across the country as state legislatures work quickly to address the growing concern of AI and automatic health claim denials.

According to a survey released by the American Medical Association, 61% of physicians are “concerned that health plans’ use of AI is increasing prior authorization denials, exacerbating avoidable patient harms and escalating unnecessary waste.”

According to a study by the Kaiser Family Foundation, 20% of claims in Affordable Care Act marketplace plans are now being denied, with much higher rates from certain insurers. About half of these denials are overturned upon appeal, but only about 1% of patients appeal a denial as many don’t know that they can.

At the same time, insurance company profits have dramatically increased. United Health alone made $14.4 billion in profits last year.

In the coming weeks, the Committee will schedule a work session for LD 1301.

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