Downcoding transparency bill heads to IL Senate floor

SPRINGFIELD, Ill. (WAND) — The Illinois Senate Insurance Committee unanimously approved a bill to prohibit insurance companies from using artificial intelligence to code a health service lower than what is actually provided to patients.

This proposal states that doctors should make all decoding decisions, and insurance companies would be required to notify providers if a service is downcoded. It would also ban insurers from downcoding in a discriminatory manner against doctors who routinely treat patients with complex health conditions.

"The problem is assistance they are using tend to only look at the final diagnosis," said Erin O'Brien from the Illinois State Medical Society. "They are basing the payment of the physician based on the final diagnosis. They are not paying us what they negotiated with us pursuant to the contracts that we negotiated in good faith."

Although the Illinois Life and Health Insurance Council opposes the idea. They argue the legislation will make it difficult to ensure insurance claims are accurate and justified.

"We believe there is a middle ground, and we look forward to working with our friends at the Medical Society to achieve that," said ILHIC President Laura Minzer.

The bill now moves to the Senate floor for further consideration.