Health insurance; review agents; artificial intelligence system; adverse determinations; effective date.
Referred to Rules
Summary
The bill mandates that any AI or automated system decision that denies or questions a health‑care service must be reviewed by a qualified medical professional before it is finalized. It also obligates insurers to give patients a clear explanation of the decision and information on how to appeal. The goal is to keep automated tools while ensuring human oversight and transparency.
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