AI Insurance Denials in 2026: Which States Now Require Physician Review

Why States Are Legislating on This Now

As payer use of AI in claims review has become more visible — through litigation, investigative reporting, and provider advocacy — a number of states have introduced or enacted legislation addressing how AI can be used in coverage determinations, generally focused on ensuring a licensed physician meaningfully reviews denials rather than an algorithm alone making the final call.

What This Kind of Legislation Typically Requires

Common provisions in this category of law include requiring that a licensed physician (often specifically one in the same or a similar specialty as the treating provider) review any denial based on medical necessity before it's finalized, and requiring insurers to disclose when AI was used in a coverage decision. The specific requirements, covered plan types, and enforcement mechanisms vary meaningfully by state and are still evolving, so providers should verify current requirements for their specific state rather than relying on a general summary.

What This Means Practically for Providers

Where this kind of requirement applies, an appeal that specifically requests confirmation of physician review — or that documents evidence suggesting a denial didn't receive individualized clinical review — may have additional leverage beyond the standard clinical necessity argument. This is a developing area of practice, and providers in states with active or pending legislation should watch for updated guidance on how to invoke these protections effectively.

This Is a Fast-Moving Area to Monitor

Given how actively state legislatures are working on this issue, any specific list of which states have enacted what requirements risks becoming outdated quickly. Providers and billing teams operating across multiple states are better served by checking current state insurance department guidance periodically than by relying on a fixed snapshot.