SPRINGFIELD, Ill. (WAND) — A bill in Springfield could prohibit health insurance companies from using artificial intelligence to code a health service lower than what is actually provided to patients.

The plan states doctors should make all downcoding decisions and insurance companies would be required to notify providers if a service has been downcoded.

Senate Bill 3114 would also ban insurers from downcoding in a discriminatory manner against doctors who routinely treat patients with complex health conditions.

"The problem is assistance they are using tend to only look at the final diagnosis," said Erin O’Brien with the Illinois State Medical Society. "They are basing the payment of the physician based on the final diagnosis. They are not paying us what they negotiated with us pursuant to the contracts that we negotiated in good faith."

The Illinois Life and Health Insurance Council opposes this idea, as they argue downcoding is beneficial when it corrects unsupported and inaccurate coding. President Laura Minzer told the Senate Insurance Committee Tuesday that downcoding also helps patients save money.

"Senate Bill 3114 makes it difficult to achieve what downcoding should achieve, ensuring that hundreds of thousands of claims that are adjudicated each day are accurate and justified," Minzer said. "But we believe there is a middle ground, and we look forward to working with our friends at the Medical Society to achieve that."

The proposal could be be brought up for a committee vote before the deadline to pass bills out of Senate committees March 13.

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