Is AI Denying Your Medical Claims?

Watch Dr. Michael Dunn of the Arizona Medical Association discuss House Bill 2175 and the risks of AI-driven denials in healthcare.

What the Doctor Says: A Quick Summary

Dr. Michael Dunn raises concerns about insurance companies increasingly using artificial intelligence (AI) to deny health claims and pre-authorizations. These decisions, often made without human oversight, can delay or block essential care. House Bill 2175 proposes a solution — requiring a licensed healthcare professional to review claims before denial.

Full Transcript:

A new bill to curb AI’s role in denying health insurance claims is making its way through the Arizona legislature. The bill calls for cases involving medical judgment to be reviewed by licensed medical professionals — not algorithms.

Dr. Michael Dunn, a family physician and Arizona Medical Association board member, explains that AI is now being used by insurers to automate claim reviews and denials. In many cases, the reasons for these denials make little sense medically — a red flag that no human reviewed them.

One recent case involved a patient treated for a cat bite. Despite correct billing codes, the insurer downcoded the claim significantly — reducing payment — based on unclear, computer-generated reasoning.

“AI is great,” Dr. Dunn clarifies. “But it should never replace a medical professional when making decisions that impact patient care.”

The bill doesn’t ban AI — it simply mandates human oversight for claim denials and pre-authorizations. This ensures safety and accountability.

The Arizona Medical Association, along with nurses, hospitals, and other healthcare groups, strongly support HB 2175. A report by the Kaiser Family Foundation found that in 2023, 1 in 5 in-network claims were denied, but only 1% were appealed — meaning most patients simply never received the care they needed.

Dr. Dunn warns that while AI can streamline some administrative tasks, its use in denying care must be tightly regulated.

“Algorithms are only as good as the data and the people programming them,” he says.

The bill has passed the House and is now being considered by the Senate. If approved, it will ensure patients aren’t unfairly denied treatment by automated systems.

Learn More About the Legislation

Read House Bill 2175 (HB 2175) – Arizona Legislature

Need Help with Denied Claims?

If you suspect AI is being used to deny your patient claims or pre-authorizations, Peregrine Healthcare can help.

• We’re experts at identifying AI-driven denials and fighting back effectively.
• We don’t just appeal claims — we win them.

Let’s protect your revenue — and your patients.
Contact us today for a complimentary claims review.