It is now illegal to use artificial intelligence to deny any medically necessary health insurance claims in California now that a new bill has gone into effect.
The Physicians Make Decisions Act aims to ensure that AI algorithms do not override the authority of medical professionals, and allow experts to determine the correct course of treatment without significant influence, according to a statement from state Sen. Josh Becker, who authored the bill.
While the bill was signed by Gov. Gavin Newsom in September, public scrutiny of insurance practices has heightened over the past several weeks following the assassination of UnitedHealthcare CEO Brian Thompson.
In the days following his death, news of a lawsuit previously filed in November 2023 resurfaced. The lawsuit claimed that UnitedHealthcare had used an AI algorithm to deny coverage for patients that doctors had deemed necessary.
UnitedHealthcare denied that the algorithm was used in coverage determinations, but instead was used as a "guide" about future potential needs the patient may have, Fierce Healthcare reported at the time.
The use of AI in healthcare is not completely banned under California's new law, but when it comes to coverage decisions, all medically necessary treatments cannot be delayed or denied by the technology.
"Artificial intelligence has immense potential to enhance healthcare delivery, but it should never replace the expertise and judgment of physicians," Becker said in a statement. "An algorithm cannot fully understand a patient's unique medical history or needs, and its misuse can lead to devastating consequences."
In light of increased focus on health insurance practices, dozens of social media users have taken turns sharing their stories online of times where they were denied care or left with hundreds of thousands of dollars in medical bills.
A doctor recently went viral on X after he shared a story of a patient in a coma getting their claim denied because it was not proven to be "medically necessary."
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