Texas lawmakers are seeking to require the state to tighten its controls over health insurance companies that use artificial intelligence (AI) to process patient claims.
Newsweek asked Texas Sen. Charles Schwertner, who introduced the new bill, for comment via email.
why is it important
The introduction of stronger controls over the use of AI in the processing of patient claims by health insurance companies is also being implemented in a number of other states, including California, Georgia, New York, and Pennsylvania.
This comes after United Healthcare CEO Brian Thompson was assassinated and some accused the health insurance company of treating customers unfairly. It comes as part of a wave of increased scrutiny of insurance companies.
Aaron M. Sprecher/CHERA (via AP)
What you need to know
Senator Schwertner introduced the bill on January 16th, which would prohibit health insurance companies from using AI technology as the “sole basis” for determining medical necessity on behalf of patients. The content is as follows.
The bill added that “only a physician or licensed health care provider acting pursuant to this chapter may determine the medical necessity or appropriateness of medical items and services.”
The bill would give the Texas Department of Insurance the power to inspect health insurance companies’ use of AI and compliance with AI rulings at any time.
According to NewsMediaJournalResource.org, health insurance companies are increasingly using AI technology to automate routine tasks, speed claims processing, and reduce administrative burden.
However, many states have raised concerns that smart software is creating inaccuracies and bias in medical decision-making, warning that patients’ medical care is not being fairly reviewed.
Major health insurance companies Humana, Cigna, and UnitedHealth all face lawsuits in early 2024 for improperly developing algorithms that guide AI programs to deny medical care, according to a report from JournalistResource.org. did.
According to Bloomberg Law, the health insurance giant used AI tools to override doctors’ recommendations for needed treatment, forcing many patients to pay for treatment out of pocket or go without treatment. has been accused of.
At least 40 states have introduced or passed AI regulation legislation in 2024 as the use of AI in health insurance decision-making comes under broader scrutiny, according to Bloomberg Law.
people’s opinions
Will Fleischer, an assistant professor at Georgetown University’s Center for Digital Ethics, told Newsweek in an email that one of the issues with using AI in health care is “transparency.”
“AI systems are often difficult for people to understand. For the most sophisticated and complex AI systems (such as large-scale language models), even the developers don’t fully understand how they work,” he said. “The lack of gender poses several problems for AI systems.” If a patient’s claim is denied by a complex AI system, companies may not be able to explain why, and even if they truly understand why, they may use the opacity of the AI system as an excuse for denial. There is a gender. Blame it on the lack of explanation. AI system opacity.
“It is also well known that AI systems suffer from algorithmic bias, where they make decisions that are biased against people from marginalized and underrepresented groups. , it could include poor performance for certain groups of people, or it could include more overtly discriminatory outcomes. In this case, bias is likely. and other marginalized groups will be more likely to be denied.”
He added: “There is a clear risk that the design of AI systems, and the social systems that rely on them to function, will be designed in a way that promotes profit at the expense of people’s health care.” Ta.
“Patients deserve a health care system that treats them like people, not data points,” Katherine McClain, spokeswoman for the Texas Patients Coalition, said in the coalition’s press release on the proposed bill. “We may play that role, but when that happens.” When making life-changing medical decisions, there is no substitute for a physician’s expertise and a patient’s unique needs. ”
“Artificial intelligence is a rapidly evolving technology that has great potential to support many systems, including healthcare,” said Texas Sen. Charles Schwertner, as reported by News Nation. However, this technology should not be used to build critical systems. When making life-saving decisions about patient care, we can never, and should never, rely solely on algorithms to understand the complexities and unique needs of patients. ”
what’s next
Senator Schwertner proposed that the bill go into effect on September 1, 2025, but it is still under consideration.
