H.R. 10210
Doctors Not AI Act of 2026
Summary:
• The "Doctors Not AI Act of 2026" prohibits AI systems from issuing or dictating adverse health insurance benefit determinations involving clinical judgment, requiring instead that a licensed health care professional with relevant training and experience make such decisions independently.
• When AI is used in the claims review process, health plans must disclose this in denial notices, including a description of the AI's role and the name, license, and credentials of the human professional who made the final determination.
• AI use in utilization review is classified as a "treatment limitation" under mental health parity law, subjecting it to parity analysis comparing its application to mental health/substance use disorder benefits versus medical and surgical benefits.
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• When AI is used in the claims review process, health plans must disclose this in denial notices, including a description of the AI's role and the name, license, and credentials of the human professional who made the final determination.
• AI use in utilization review is classified as a "treatment limitation" under mental health parity law, subjecting it to parity analysis comparing its application to mental health/substance use disorder benefits versus medical and surgical benefits.
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