Your insurance denial now requires a real doctor's signature

What it does

This bill requires Medicare Advantage insurance plans to have a licensed physician personally review and approve any prior authorization denial that was informed by artificial intelligence before the denial is issued. The physician must attest in writing that they exercised independent medical judgment and that the AI did not dictate the decision. Plans must disclose to patients and providers that AI was used, provide the physician's identifier, and maintain records for 10 years. The bill also requires plans to report to the Secretary of Health and Human Services every 90 days on AI-assisted denials and gives HHS authority to audit and inspect these practices.

Why we flagged it

The bill's operative mechanism is a regulatory requirement imposing human-review and transparency obligations on Medicare Advantage plans' use of AI in denial decisions. It is fundamentally a patient-protection and insurance-oversight measure, not a subsidy, carve-out, or deregulation.

What the text implies

• Plans may respond by hiring more physician reviewers, increasing administrative costs that could be passed to enrollees through higher premiums or reduced benefits.
• The 10-year record-retention requirement creates a detailed audit trail that could expose patterns of inappropriate denials, potentially triggering enforcement actions or litigation.

The full analysis lists 4 implications of this text.

Who it affects

Ordinary patients and their doctors gain transparency, human oversight, and documented accountability in insurance denial decisions that directly affect their access to care. The requirement for independent physician review and attestation creates a meaningful check on automated denials that could otherwise block necessary treatment without human clinical judgment.