OLYMPIA — A bipartisan bill restricting the use of artificial intelligence (AI) in making prior authorization determinations was heard in the House Health Care & Wellness Committee Wednesday.
Senate Bill 5395, sponsored by Sen. Tina Orwall (D-Des Moines), prohibits private insurance companies and Washington’s public employee health programs from using AI as the only means to deny, delay, or modify health care services for patients.
Under the bill, which passed nearly unanimously in the Senate, health plans may use AI to process and approve prior authorization requests under certain conditions, but a licensed provider must review them to deny care based on a determination of medical necessity.
“When insurers are slammed with a massive of volume of prior authorization requests, AI has the power to help expedite these determinations and connect patients to care quickly,” Orwall said. “But when it comes to denying care, only physicians should have the power to make these determinations because they’ve taken an oath to do no harm — and that’s something AI systems simply cannot do.”
Rep. Alicia Rule (D-Blaine), the sponsor of the House companion bill, said the legislation brings necessary transparency to the prior authorization determination process.
“When people need medical care, the prior authorization process often slows access to treatment and is a barrier to care,” Rule said. “When a prior authorization is needed, those decisions should be made by qualified medical professionals, not AI. This bill brings clarity and transparency to the process to reduce delays in timely care and preserve decision making grounded in humanity.”
In 2022, Cigna doctors denied more than 300,000 claims over two months through an algorithm-based review process, spending an average of 1.2 seconds on each case. Additionally, a 2024 American Medical Association survey found more than 60% of physicians are concerned that health plans’ use of AI will increase prior authorization denial rates.
Bindu Nayak, a Wenatchee-area endocrinologist and vice president of the Washington State Medical Association, said the organization supports the bill because it would help ensure AI systems are not being used to deny care.
“The Washington State Medical Association supports SB 5395 to ensure that prior authorization decisions remain grounded in individualized clinical judgment — not opaque AI systems,” Nayak said. “While technology can assist administrative processes, it must not be used in ways that delay care or override physician expertise. Patients deserve transparency, accountability, and timely access to medically necessary treatment.
The bill also requires transparency in prior authorization processes and that health carriers, when denying prior authorization, include the credentials, board certifications, and specialty areas of providers who had clinical oversight of determinations when issuing notices to enrollees. For patient care that already had prior authorization, health carriers would also be prohibited in most circumstances from retrospectively denying coverage or modifying to lower services than what was approved in the original requests.
Other Washington physicians and health care leaders voiced their support for the bill, including EvergreenHealth CEO Ettore Palazzo and Confluence Health CEO Andrew Jones.
“SB 5395, also known as the Prior Authorization Bill, ensures that medical decisions continue to be made by qualified clinicians who know the patient. As health care providers, it is our commitment to every patient we serve that we deliver the safest, highest-quality care possible. Requiring human review and transparency in prior authorization are imperative measures to protect patient safety and support evidence-based, individualized care,” Palazzo said.
“SB5395 helps ensure patients get the care their physician knows they need—without unnecessary delays. I applaud the legislature’s effort to adopt standards limiting the use of AI in care authorization. By setting clear timelines and preventing last‑minute denials after care is approved, the bill provides patients with peace of mind and allows clinicians to focus on those patients, not navigating red tape,” Jones said.
