Florida lawmakers target AI in insurance claim denials
A Florida Senate committee has approved a bill that would prevent insurers from using artificial intelligence as the sole basis for denying claims, with the proposal saying decisions should be made by a "qualified human professional,"
The Senate Banking and Insurance Committee unanimously backed the proposal, which comes as other states also have looked at the use of artificial intelligence in insurance decisions.
"We want to make sure that we strike the right balance between allowing innovation but also protecting consumers from unaccountable algorithms," bill sponsor Jennifer Bradley said.
The need for the human factor
The bill would place a series of requirements on insurers, including saying that a decision "to deny a claim or any portion of a claim must be made by a qualified human professional." Such people would have to analyze claims and the insurance policies and "review the accuracy of any output generated" by an artificial intelligence system, machine learning system or algorithm.
"An algorithm, an artificial intelligence system or a machine learning system may not serve as the sole basis for determining whether to adjust or deny a claim," the bill says.
A Senate staff analysis said other states, the U.S. Department of Health and Human Services and the National Association of Insurance Commissioners in recent years have sought to address the use of algorithms and artificial intelligence in insurance decisions.
As an example, the analysis said California last year passed a measure that seeks to ensure decisions about medical care are made by health-care providers and not solely by artificial intelligence used by insurers. The analysis also said lawsuits were filed during the past three years in California and Minnesota involving allegations about health insurers using artificial intelligence to screen claims or deny coverage.
While Bradley's bill drew little discussion on Tuesday, the Florida Medical Association, which represents physicians and sometimes tangles with insurers, indicated its support.
Bradley said she has had discussions with insurers to resolve issues about the bill.
"While AI can improve efficiency and accuracy in certain cases, the bill seeks to mitigate risks related to potential inaccuracies and biases," she said. "It highlights the importance of human judgment and decisions, ensuring technology supplements rather than replaces critical human oversight."
The bill would need approval from two more committees before it could go to the full Senate.
Republican Rep. Hillary Cassel, of Dania Beach, has filed a broader House insurance bill that would require human reviews of claim denials. That bill has not been heard in committees.
