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Bill

SB 815

Relating to the use of certain automated systems in, and certain adverse determinations made in connection with, the health benefit claims process.

89th Legislature (2025) Introduced by César Blanco and 4 co-sponsors

Texas SB 815 mandates human review and transparency requirements for automated health insurance claim denials, effective September 1, 2025.

Effective on 9/1/25
#audits&auditors(s4334) #artificialintelligence(iq7c5) #computers&software(s2425) #electronicinformationsystems(i0311) #healthmaintenanceorganizations(s0853) #healthcareproviders(i0387) #insurance #commissionerof(v0396) #insurance--health&accident(i0422) #insurance--insurers&agents(i0425) #physicians(s1282)
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Bill Summary · SB 815

Legislative bill overview

SB 815 regulates the use of automated systems in health insurance claims processing and decision-making. The bill establishes requirements for transparency, human review, and appeals when insurers use automated technology to deny or adversely determine health benefit claims.

Why is this important

Health insurance denials directly affect patient access to medical care and financial security. As insurers increasingly rely on automated algorithms to make coverage decisions, this bill aims to ensure these systems don't unfairly deny claims without human oversight and that patients understand why their claims were denied.

Potential points of contention

  • Compliance burden: Insurers may argue the requirements increase administrative costs, which could be passed to consumers through higher premiums
  • Speed vs. accuracy: Requiring human review of automated denials may slow claims processing, potentially delaying necessary medical treatment
  • Definition ambiguity: The bill's specific requirements for "automated systems" and what constitutes "adverse determinations" may create litigation over regulatory interpretation and enforcement
  • Scope limitations: The bill may not address all decision-making scenarios or AI/machine learning systems used upstream in claims triage

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

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