New Arizona Law Requires Doctor Approval Before Insurance Denials

Health insurers in Arizona will soon face new requirements regarding coverage decisions, following the passage of House Bill 2175. This legislation mandates that a licensed physician must review any denial of medically necessary care before any such decision is finalized. Introduced by Republican House Majority Whip Julie Willoughby (R-LD13), it garnered significant bipartisan support within the state legislature.

The new law stipulates that an Arizona-licensed medical director must actively evaluate any denial related to medical necessity—this includes both prior authorizations and claims. Importantly, this reviewing physician is expected to apply independent medical judgment, rather than relying on automated systems or algorithms.

“This law ensures that a doctor, not a computer, is making medical decisions,” Willoughby emphasized. “If care is denied, it should be by someone with the training and ethical duty to put patients first.”

Set to take effect on July 1, 2026, the law offers insurers a transition period to adjust their internal processes. This timeline allows companies to ensure compliance, particularly in staffing qualified physicians for the review process.

The impetus for this legislation arises from growing national concerns regarding insurers’ use of automated tools in claims processing. Critics argue that such technologies can result in care denials lacking sufficient clinical oversight, adversely affecting patient well-being.

Supporters of HB 2175 contend that the law introduces essential checks on these automated systems, repositioning medical decision-making within the realm of qualified professionals committed to patient welfare.

“Arizona families deserve real oversight when it comes to life-changing medical decisions,” Willoughby stated, underscoring the law’s intent to prioritize patient care over profits.

The legislation is part of the House Republican Majority Plan, which advocates for individual rights and transparency within the system. Despite its Republican sponsorship, the bill’s bipartisan support indicates broad legislative consensus on the necessity for enhanced oversight in insurance determinations.

The rollout of HB 2175 will be closely monitored by healthcare advocates, insurers, and policy analysts, positioning Arizona as a significant player in regulating the intersection of AI and healthcare decision-making.