Anwar would bar AI from making health care decisions

In an ever-changing, tech-driven world, artificial intelligence systems are becoming increasingly pervasive each year. At the same time, lawmakers across the country and in Connecticut are looking to legislation as a way to regulate it, especially in the health care field.

One such bill, proposed by state Sen. Saud Anwar, D-South Windsor, aims to amend the state's code to prohibit health insurance carriers from using AI to determine patient care "to safeguard patient access to testing, medications and procedures."

He said the bill comes after a ProPublica investigation found how Connecticut-based Cigna Insurance was refusing care to patients with the help of AI-guided algorithms during the prior authorization process. According to the investigation, Cigna doctors denied over 300,000 requests for payments using an automated system driven by AI, spending an average of 1.2 seconds on each case, over two months in 2022. Since then, there been a flurry of lawsuits against large health insurance companies -- including UnitedHealth -- alleging the improper use of AI to deny health care faster, following a similar investigation.

Anwar, who is a medical doctor specializing in diseases of the lungs, said these quick denials of care increase "stock value at the cost of human beings," as patients "will die ... some of them will live in agony and pain" while waiting to access the care they need.

Patients "deserve a human being on the other side to be able to look at things, rather than an artificial intelligence algorithm, which is basically trained to deny care, so that some of the times insurance companies can make more profits," Anwar said. "That is unethical, immoral and wrong for the patients."

It's not new for health payers to use algorithms in their administrative process; AI is the next natural step for that technology, said Paul Kidwell, senior vice president of policy at the Connecticut Hospital Association. However, the trend needs a watchful eye to ensure transparency when the algorithms are used in this way.

He said every patient and the care they need is different, so it makes staff wonder who makes the prior authorization denial decisions in "two seconds," given the complexity of each person's care.

A recent American Medical Association survey found that three in five physicians nationwide are concerned about using AI to increase prior authorization denials, overriding "good medical judgment and systematically denying patients coverage for necessary medical care."

When providers go through the "exhausting" and "unnecessarily complex" process of appealing, Kidwell said most denials are ultimately overturned, costing time and money for the hospital and creating barriers to care for patients.

Susan Halpin, executive director of the Connecticut Association of Health Plans, said health carriers do not use AI to make health decisions with those remaining in the "domain of humans."

"Given the time-sensitivity of all health care interactions, and the gravity of decisions made by the minute, health carriers vary in their deployment of [artificial intelligence systems], but all rely on the work of a Human-in-the-Loop, for critical decision making," Halpin said in an email statement to CT Insider.