WeVote
Log In

Bill

Bill

HB 5587

AN ACT PROHIBITING HEALTH INSURERS FROM USING ARTIFICIAL INTELLIGENCE AS THE PRIMARY METHOD TO DENY HEALTH INSURANCE CLAIMS.

2025 Regular Session Introduced by Nick Menapace

HB 5587 bans health insurers from using AI as the primary method to deny claims, ensuring human review and transparency in denial decisions.

REF. TO JOINT COMM. ON Insurance and Real Estate
#artificialintelligence #healthinsuranceclaimsdenials
0
WeVote Research Nonpartisan
Bill Summary · HB 5587

Summary of HB 5587

Overview

  • Bill Number: HB 5587
  • Title: AN ACT PROHIBITING HEALTH INSURERS FROM USING ARTIFICIAL INTELLIGENCE AS THE PRIMARY METHOD TO DENY HEALTH INSURANCE CLAIMS
  • Intent: To restrict health insurers from relying primarily on artificial intelligence as the main basis for denying health insurance claims, with the aim of ensuring that denial decisions are not predominantly AI-driven.

Status and Legislative History

  • Introduced: March 14, 2025
  • Initial Referrals: January 21, 2025 – Referred to Joint Committee on Insurance and Real Estate
  • Filed: March 14, 2025
  • First Reading / Referral: April 7, 2025 – Read first time; Referred to Insurance

What the Bill Would Do

  • Primary Prohibition: The bill would prohibit health insurers from using artificial intelligence as the primary method to deny health insurance claims.
  • Scope and Details: The exact definitions (e.g., what qualifies as “AI,” what constitutes “primary method,” and potential exceptions) are not specified in the provided text. The bill's substantive provisions, enforcement mechanisms, remedies, and any performance standards would be clarified during committee review.

Who Would Be Affected

  • Primary Stakeholders: Health insurers and entities involved in processing and denying health insurance claims.
  • Claimants: Individuals insured by health plans that may be subject to AI-driven denial decisions, as well as health care providers who submit claims.

Procedural and Timeline Considerations

  • The bill is advancing through the legislative process with committee consideration on the horizon after the first reading. Key steps ahead typically include:
    • Development of definitions and any carve-outs or exceptions
    • Establishment of enforcement, penalties, and appeal rights
    • Potential fiscal impact assessments (if applicable)
    • Committee votes and potential floor consideration

Potential Impacts to Watch

  • Consumer Protections: Expectation of increased transparency and human review in denial decisions, pending final text.
  • Operational Changes for Insurers: If AI usage is limited or restricted, insurers may need to adjust claims processing workflows, include additional review steps, and enhance documentation of denial rationales.
  • Technology and Vendors: Possible shift in AI usage strategies for claims processing and potential implications for third-party deny-rights providers.
  • Appeal and Transparency Provisions: The final bill may establish requirements for disclosure of denial reasons and patient rights to appeal, subject to the final drafting.

Next Steps

  • Await the committee’s drafting of definitions, safe harbors, and enforcement details.
  • Monitor for hearings, potential amendments, and any fiscal notes or policy reports accompanying the bill.

Compiled from official sources — confirm details with the bill’s official record.

Sign in to ask a question.