Artificial intelligence is becoming a bigger part of life, including in the healthcare industry. Insurance companies may use it to eradicate fraud, but doctors worry that it can also be used to tee up refusal.
Austin's Texas legislators will discuss whether and how much technology should be restricted.
Michele Rays on Friday is a patient with hypoparathyroidism and advocate for the Texas Coalition for patients. She is in the middle of the drug claim process. She didn't want to identify which insurance companies were handling the claims, fearing retaliation.
“It went through a previous approval process and rejected it, then it went on to reject it, then it was another appeal, it was denied,” Rays told NBC 5.
She didn't know that artificial intelligence bots could take action on her claims before talking to humans through the helpline.
“Each situation should be taken on a case-by-case basis, whatever it is, whether it is a drug. Those rejections should not be about the group dataset,” Rays said.
At the state capitol in Austin, a bill by Senator Dr. Charles Schwartner, R-Georgetown opened another front during a long, offensive battle between doctors and insurance companies. His Senate Bill 815 aims to prohibit health insurance companies from using artificial intelligence to deny, modify or delay claims. During the committee hearing on the bill on Thursday, he argued that AI was being used to tease thousands of actions on bills for healthcare workers to press buttons to take a massive amount of action.
“As we know, insurers, in my opinion, are deploying revenue-focused artificial intelligence, with insurance companies focused on patients' well-being,” Schwartner said.
SB 815 also allows the Texas Department of Insurance to inspect insurance companies via AI, requiring more transparency in patients.
“A long-term insurance company has been hidden in an automated process,” Schwartner said.
However, on Thursday, an alternative was rolled out that worried Sen. Royce Kolhorst. She feared that the language and definition of the proposal would make it too broad and affect state-controlled insurance programs, such as Medicaid and the Children's Health Insurance Program.
Senator Kolhorst feared it would get in the way of claim fraud and the state's efforts to eradicate “upcodes” in which doctors inappropriately charge to make more money. These concerns were echoed by the insurance industry group, the Texas Health Planning Association, and the Jamie Presidential Association.
“It creates complexity enough to create obstacles to not being able to chase large scale fraud, waste, abuse and claim errors,” Dudensing said.
AI can be used to identify large amounts of data discrepancies.
In a post-trial statement, a spokesman for the Texas Health Planning Association wrote NBC 5.
The Texas Medical Association, an industrial group of doctors at the Capitol, supported Senator Schwartner's bill, arguing that it would help prevent “downcoding” insurers from not paying patient physician-supported care and not saving insurance companies money.
“We see software in the market, which is more powerful than what we could have predicted,” says Dr. Zeke Silva of the Texas Medical Association.
“Nothing about this bill prevents us from pursuing fraud or abuse,” Dr. Silva said.
Physician groups and health insurance companies are often intertwined with each other on the Capitol, around payments, scope of practice, and responsibility.
The bill was left pending at a committee awaiting further debate and debate.
