Aimed Alliance submitted written testimony regarding Washington’s Senate Bill 5395 and House Bill 1566, which aim to improve transparency and accountability in the prior authorization process, particularly when artificial intelligence (AI) is involved in coverage determinations.
The letter expressed Aimed Alliance’s support for the bills’ provisions that prevent AI from being the sole basis for denying or modifying care, limit prior authorization policy changes to once per year, and require insurers to disclose the credentials of individuals making these decisions. However, it urged lawmakers to further strengthen the companion bills by mandating that denial letters explicitly state whether AI was used in the decision-making process and to what extent.
This concern is demonstrated in two recent class action lawsuits arguing that Medicare Advantage plans were using AI to deny a substantial number of claims with a known 90 percent error rate. Patients and providers are often unaware when AI is used to make coverage decisions, making it difficult to challenge inappropriate denials. Thus, disclosing the use of AI in these coverage decisions will empower patients and providers to challenge unfair denials more effectively. Read the letter here.
Last Updated on February 7, 2025 by Aimed Alliance
