Every day, patients are hit with the news that the treatment their trusted physician ordered has been denied. Now imagine learning that no human, let alone a doctor, even looked at the claim before the denial was issued. It’s not a science fiction plot, but rather the new frontier in health care.
At the center of the issue is prior authorization, a process by which insurers require approval before certain services, prescriptions and treatments can move forward. What began as a cost-cutting measure has morphed into a major barrier for patient care: According to the American Medical Association (AMA), one in three physicians report that prior authorizations are often or always denied, leading to an average of 13 hours a week spent working to cut through prior authorization-related red tape.
Prior authorizations and claim denials slow down patient care, often resulting in worse health outcomes and higher costs in the long run. Now, the rise of artificial intelligence is taking matters out of doctors’ care altogether, and physicians like me are concerned. Will AI become an automated gatekeeper programmed to say “no,” doling out denials left and right with little regard for patient outcomes?
