An Act To Ensure Human Oversight In Medical Insurance Payment Decisions

LD 955 prohibits Maine health insurance carriers from denying claims or coverage solely based on artificial intelligence decisions, effective January 1, 2026. It requires carriers to conduct physician reviews - by a licensed Maine doctor - before denying benefits or reducing payments using AI, covering medical necessity, provider judgment, and health impacts. Carriers must submit quarterly reports to the state on AI-related denials and appeals, with annual summaries by the state bureau starting in 2027. The bill applies directly to insurers, healthcare providers submitting claims, and policyholders affected by coverage decisions.