Venkat legislation to regulate use of artificial intelligence in processing health insurance claims discussed in committee

Rep. Arvind Venkat    October 1, 2024 | 2:31 PM

HARRISBURG, Oct. 1 – State Rep. Arvind Venkat’s bill that would provide greater oversight to the implementation of artificial intelligence by health insurance companies when determining the appropriateness of claims was the subject of an informational hearing today in the Pennsylvania House Insurance Committee.

“The rapid growth in the use of artificial intelligence in the health industry may help improve the efficiency of processing insurance claims, but streamlining this process may deprive people of the human connection essential in doctor-patient relationships,” said Venkat, D-Allegheny. “My bill would not only keep that bond intact, but it would ensure that the deciding determination of claims is in the hands of qualified medical professionals and out of the hands of software programmed to make that call.”

House Bill 1663 would place several requirements regarding AI that insurers must follow. They are:

  • Disclosing to clinicians, subscribers and the public that claims evaluations use AI algorithms.
  • Defining “algorithms used in claims review” as clinical review criteria and, therefore, ensuring they are subject to existing laws and regulations that such criteria is grounded in clinical evidence.
  • Requiring specialized health care professionals who review claims for health insurance companies and rely on initial AI algorithms for such reviews to individually open each clinical record or clinical data, examine this information, and document both their own review and reason for denial before any decision to deny a claim is conveyed to a subscriber or health care provider.
  • Requiring health insurance companies to submit their AI-based algorithms and training datasets to the Pennsylvania Department of Insurance for transparency and require the department to certify that said algorithms and training data sets have minimized the risk of bias, based on categories outlined in the Human Relations Act and other anti-discrimination statutes as applicable to health insurance in Pennsylvania, and adhere to evidence-based clinical guidelines.

House Bill 1663 will be the subject of further deliberations in the committee as a result of today’s testimony.

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