Will AI fix prior authorization—or make it worse?
Summary
Prior authorization is a process where health insurers approve medical care before patients receive it. Artificial intelligence (AI) might help speed up approvals but also raises concerns about wrong denials. The government and insurers are trying new rules and programs to reduce delays and improve the process.Key Facts
- Prior authorization is needed to get insurance approval for certain medical treatments and medications.
- Many doctors worry that AI use could increase wrongful denials of necessary care.
- A 2025 survey found 61% of physicians are concerned AI will worsen denial rates.
- President Donald Trump’s administration is testing AI programs in six states to cut unnecessary medical costs.
- Medicare Advantage plans deny millions of claims yearly based on prior authorization rules.
- About 20% of working-age adults with private insurance experienced denied care in 2025.
- Delays in care from denials sometimes cause patients’ health to get worse.
- New government rules since 2024 require faster decisions on prior authorizations, especially for urgent care.
Read the Full Article
This is a fact-based summary from The Actual News. Click below to read the complete story directly from the original source.
