North Carolina lawmakers are taking a stand against "surprise billing" by hospitals and excessive AI-driven health insurance claim denials. The state Senate passed a bipartisan bill to require hospitals to be more transparent about costs before procedures, ensuring patients receive itemized and understandable bills. Meanwhile, another bill is being considered to prevent AI from being the sole reason for health insurance claim denials. The goal? To protect patients from unexpected expenses and unfair rejections for medical care. While similar efforts have failed in the past due to hospital industry lobbying, public pressure and recent incidents—like the killing of UnitedHealthcare’s CEO—may push these reforms forward.

Key Points:

• Surprise Billing Crackdown

  • Senate Bill 316 aims to require hospitals to disclose costs before procedures.
  • Patients must receive an itemized bill in plain language before being sent to collections.
  • Previous attempts failed due to strong opposition from the hospital industry.

• AI in Health Insurance Claims

  • Senate Bill 315 seeks to prevent AI from being the sole decision-maker in claim denials.
  • Insurers must allow appeals to be reviewed by licensed doctors in that medical specialty.
  • The bill bans retroactive prior authorizations that could lead to sudden claim denials.

• Major Industry Impact

• The North Carolina Healthcare Association declined to comment on the new bill.

• UnitedHealthcare, facing a class-action lawsuit over AI-driven denials, was cited during discussions.

Sen. Amy Galey summarized the issue bluntly: "There is, I think, no other industry that a consumer agrees to pay for a service in advance with no clue as to what the cost will be." Whether these bills will overcome industry resistance remains to be seen, but patient advocacy groups are watching closely.
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