Becker's: Physicians warn AI is driving up prior authorization denials

Here are five notes on physicians’ growing concern about AI use in prior authorization:

1. In a recently released AMA survey, 61% of physicians said they feared that payers’ use of unregulated AI was creating more prior authorization denials, which can cause delays in treatment and harm patients.

2. “Emerging evidence shows that insurers use automated decision-making systems to create systematic batch denials with little or no human review, placing barriers between patients and necessary medical care,” AMA President Bruce Scott, MD, said.

3. The AMA claims that healthcare spending rises under the use of AI in prior authorizations due to the additional office visits, unanticipated hospital stays and out-of-pocket costs for treatment that arise from prior authorization denials.

4. In the survey cited in the report, 82% of physicians reported that prior authorization sometimes leads to patients abandoning treatment plans altogether, while over 90% said that prior authorization delays care.

5. Another AMA survey, released in February, found that 49% of physicians ranked oversight over payers’ use of AI in medical necessity determinations to be a top-three priority for regulatory action.