The US government is testing AI-based systems to speed up insurance prior authorizations, a requirement for many medical treatments that often leads to delays and care interruptions. While AI promises efficiency, physicians worry it could worsen denial rates and complicate patient access to necessary care.
- US pilots AI to reduce delays in prior authorizations
- Doctors fear AI may increase wrongful denials
- Reforms aim to speed decisions but challenges remain
What happened
Despite these initiatives, prior authorization remains a prevalent hurdle. Millions of Medicare Advantage claims are denied annually, sometimes even for essential services such as skilled nursing care. Patients frequently report treatment delays, and some experience worsening health conditions due to prolonged waits or denied coverage. A 2025 survey found that 20% of working-age Americans with private insurance faced denials impacting medical care.
Why it matters
Prior authorization aims to control rising healthcare costs by screening for medically unnecessary procedures, but it often results in significant delays that can harm patient health. Physicians have expressed major concerns about the potential for AI to exacerbate this issue. A 2025 American Medical Association survey revealed that 61% of doctors worry AI will increase wrongful denials, worsening patient access to required care. The AMA advocates for transparency in AI algorithms and detailed insurer explanations when claims are rejected.
What to watch next
Private insurers have committed to reducing the volume of services requiring prior authorization and standardizing electronic processes. However, ongoing stakeholder input, including from physicians and patient advocacy groups, will be important to prevent AI systems from becoming opaque gatekeepers. Transparency, accountability, and clinical oversight will likely shape the future of AI-assisted prior authorization in the US healthcare system.