LAMPASAS, Texas (KXXV) — A Texas lawmaker is pushing to limit the role of artificial intelligence in processing health insurance claims, arguing that critical medical decisions should be made by humans, not algorithms.
State Rep. David Spiller has introduced House Bill 2922, which would prohibit health insurance companies from using AI to delay, deny, or modify claims. Spiller said the bill is necessary to protect patients and ensure their medical care is guided by doctors rather than unregulated technology.
“When Texans are seeking medical care, they expect that care to be guided by their doctor,” Spiller said in a statement to 25 News. “Artificial intelligence should not be influencing the care of patients. The technology is unregulated, and there are no safeguards in place to ensure that algorithms put patients over profits. The care of Texans is simply too important to put in the hands of AI.”
For years, AI has played an increasing role in reviewing and processing health insurance claims. Some argue this shift has led to patients falling through the cracks due to automated denials and delays in approval.
Dr. Scott Hecox, an orthopedic hand surgeon at Baylor Scott & White Hillcrest, said AI-driven decisions can negatively impact patient care.
“The AI will see the claim, run through the algorithmic process, and then either pause or deny the claim without any kind of human intervention or review,” Hecox said.
“When it comes to patients' success and outcomes, we feel like a human who has a medical background, who has some kind of compassion, empathy, and sensitivity to the way that medicine is practiced, is critical in order to provide the best quality of care.”
Hecox acknowledged that AI has benefits in the medical field but believes its use in insurance decisions can have consequences.
“From a community standpoint, what we’re doing is, at worst, delaying care or denying care just outright, and that’s a big concern for us,” Hecox said. “There are several things in medicine that definitely worsen over time if they’re not addressed on the front end, instead of on the back end.”
Texas is not alone in addressing this issue. Arizona and California have already passed measures to limit AI’s role in processing health insurance claims.
HB 2922 is currently under consideration in the Texas Legislature.
