Did a bot deny your claim? NC lawmakers want to regulate AI in health insurance :: WRAL.com
Did a bot deny your claim? NC lawmakers want to regulate AI in health insurance :: WRAL.com
Publish Date: 2026-05-21 17:12:00
Source Domain: www.wral.com
North Carolina Republican lawmakers are pushing a proposal that would limit how artificial intelligence can be used in healthcare, aiming to protect consumers against technology that could lead to bigger bills or denied claims.
“We do not want robots or computers to deny care to sick people,” state Sen. Amy Galey, R-Alamance, said Wednesday during a committee meeting Wednesday.
House Bill 565 would prohibit insurers from using AI as the sole basis for denying healthcare claims or prior authorization requests, saying that humans must remain involved in those decisions.
The legislation also seeks to crack down on hospitals and other healthcare providers that might use AI to inflate their profits through a strategy called “upcoding.” The treatment patients receive, and which they or their insurers are billed for, are cataloged using a highly specific set of thousands of codes. Higher billing codes can lead to higher reimbursements from insurers, Medicaid or the state health plan, increasing overall healthcare costs and potentially leading to people paying higher premiums as well.
When done intentionally, upcoding can constitute fraud. But when AI is making the decisions instead of humans, healthcare policy experts say, the AI could unintentionally push billing systems toward more expensive codes if there are not clear safeguards and human oversight.
“We know that AI can amplify what already exists,” said Alessandra Bazzano, a professor at UNC Gillings School of Public Health. “If there’s a reimbursement algorithm that rewards severity or intensity, those AI tools might accelerate pressure toward doing that kind of higher…
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