Physicians Concerned AI Increases Prior Auth Denials
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A growing number of physicians are sounding the alarm over the health insurance industry’s use of unregulated artificial intelligence (AI) in prior authorization decisions, raising concerns that automated denials are delaying necessary care and harming patients. According to a recent American Medical Association (AMA) survey, 61% of physicians believe AI-driven prior authorization is increasing denials and exacerbating healthcare waste.
Physicians have long struggled with burdensome prior authorization requirements, but AI tools are now generating large-scale denials—some at rates 16 times higher than normal—without proper human review. The consequences are severe: 29% of physicians report serious patient harm due to prior authorization delays, including hospitalizations, permanent impairment, or even death. Additionally, 93% say prior authorization disrupts care, forcing patients to either pay out-of-pocket, abandon treatment, or experience worsened health outcomes.
The administrative burden is also overwhelming, with physicians completing an average of 39 prior authorizations per week, consuming approximately 13 hours of physician and staff time. Nearly 90% of physicians report that prior authorization contributes to burnout, further straining an already overburdened healthcare workforce.
Despite industry promises to reduce prior authorization barriers, insurers like UnitedHealthcare and Cigna have made minimal improvements, with only 16% of physicians noticing any reduction in prior authorizations. Physicians overwhelmingly rank UnitedHealthcare, Humana, Anthem/Elevance, Aetna, Cigna, and Blue Cross Blue Shield as the worst offenders in imposing excessive administrative hurdles.
The AMA continues to advocate for greater oversight of insurers’ use of AI in medical necessity determinations and urges policymakers to ensure AI augments, rather than replaces, human medical judgment. Physicians and patients can join efforts to fix prior authorization by sharing their experiences at FixPriorAuth.org.
Physicians concerned AI increases prior authorization denials (AMA, 2/24).
