Maine Senate Bill LD955

Maine 2025-2026 Regular Session

• Introduced: 3/6/25
• Refer: 3/6/25
• Failed: 5/20/25

Caption

An Act to Ensure Human Oversight in Medical Insurance Payment Decisions

Summary

LD 955 would regulate how health insurance carriers in Maine use artificial intelligence in coverage and payment decisions. Beginning January 1, 2026, a carrier could not deny a claim or coverage solely because an AI system recommended denial. The bill defines artificial intelligence broadly as a computerized system that makes decisions or recommendations based on algorithms and data analysis. The bill also requires human review before certain adverse insurance actions are taken. If a carrier intends to deny benefits or reduce payment using AI in medical review or utilization review, it must first conduct a utilization review by a physician licensed in Maine. That review must consider medical necessity, the treating provider’s professional judgment, and the effect of the denial or payment reduction on the enrollee’s health outcomes. Enrollees and providers would retain appeal rights under existing law.

Impact

LD 955 would amend Maine insurance law to prohibit AI-only denials of health plan claims and to require licensed physician oversight before AI-influenced denials or payment reductions. It would also create new reporting obligations for carriers on AI-related denials and appeals, and require the Bureau of Insurance to compile and submit annual summaries to the Legislature. In addition, the Bureau of Insurance must adopt related rules by November 1, 2025, making the bill both a substantive regulation of insurer practices and an administrative mandate for oversight and rulemaking.

Sentiment

The bill’s stated purpose and structure suggest a generally favorable policy direction toward stronger human oversight in insurance decisions, especially in medical coverage determinations. Because no committee transcript or vote record is provided, there is no direct evidence of debate or recorded support/opposition. Based on the text alone, the bill appears designed to address concerns about automated claim denials and to reassure patients and providers that a licensed physician will review adverse decisions.

Contention

The main point of contention likely concerns the use of artificial intelligence in insurance utilization review. Supporters would likely emphasize patient safety, accountability, and the need for physician judgment in medical necessity decisions, while opponents may argue the bill could limit insurer efficiency, increase administrative costs, or restrict the use of AI tools that help manage claims. Another possible issue is the breadth of the AI definition and whether the physician-review requirement could slow down coverage decisions or create compliance burdens for carriers.