Becker’s: California clamps down on AI-based coverage denials

Author: Andrew Cass | January 6, 2025

A new California law went into effect Jan. 1 that prohibits payers from making coverage decisions based solely on artificial intelligence algorithms. 

Under the new law, any denial, delay or modification of care based on medical necessity must be reviewed and decided by a licensed physician or qualified healthcare provider with expertise in the specific clinical issues at hand, according to a Dec. 9 news release from California Sen. Josh Becker, the bill’s sponsor. 

“Artificial intelligence has immense potential to enhance healthcare delivery, but it should never replace the expertise and judgment of physicians,” Mr. Becker said in the release. “An algorithm cannot fully understand a patient’s unique medical history or needs, and its misuse can lead to devastating consequences.”

This article was originally published on Becker’s.