Arizona law requires physician review of denied health insurance claims
Arizona has taken a stand against health insurance companies using computer systems to deny claims with a new law set to go into effect in July 2026. The legislation, sponsored by Republican Arizona House Majority Whip Rep. Julie Willoughby and signed into law by Democratic Gov. Katie Hobbs, requires a licensed physician in the state to conduct an “individual review” and use “independent medical judgment” to determine whether a claim should be denied.
House Bill 2175 also mandates a similar review for “a direct denial of a prior authorization of a service” that involves medical necessity. The goal is to ensure that medical decisions are made by doctors, not computers. Willoughby emphasized the importance of prioritizing patients over profits and restoring accountability in the healthcare industry.
The bill received nearly unanimous support in both chambers, highlighting the bipartisan concern over the use of computer systems to deny claims. Healthcare companies like Cigna and United Healthcare have faced accusations of relying on AI algorithms to reject claims in the past, raising concerns about the impact on patient care.
Similar legislation was enacted in California last year, known as the “Physicians Make Decisions Act,” which aimed to address the growing reliance on artificial intelligence in healthcare. Democratic state Sen. Josh Becker expressed the importance of preserving the expertise and judgment of physicians in medical decision-making, highlighting the potential consequences of misusing algorithms in patient care.
The new Arizona law underscores the state’s commitment to ensuring that healthcare decisions are made with the best interests of patients in mind. By requiring physician reviews of denied claims, the legislation aims to prevent the misuse of computer systems in denying essential healthcare services. Patients in Arizona can now have greater confidence that their medical needs will be evaluated by qualified healthcare professionals rather than automated processes.
As the healthcare industry continues to evolve, it is crucial to maintain a balance between technological advancements and human expertise in medical decision-making. Arizona’s proactive approach to addressing this issue sets a positive example for other states to follow in safeguarding the integrity of healthcare services.
