Will AI Fix Prior Authorization -- Or Make It Worse?

Will AI Fix Prior Authorization -- Or Make It Worse? looks at a U.S. pilot program using artificial intelligence for insurance prior authorization decisions, and the risks it may bring. The article explains that prior authorization is meant to curb wasteful spending by requiring insurers to approve recommended prescriptions, procedures, and other services, but it can delay care and prompt patients to abandon treatment while insurers verify medical necessity. Patients can appeal denials, yet appeals take additional time. The piece says AI could speed approvals for claims deemed clearly allowable, but resistance is growing over concerns about wrongful denials. A 2025 American Medical Association survey found 61% of physicians worried that AI would worsen denials of necessary care, and the AMA urges insurers to provide detailed clinical reasoning and greater transparency about algorithms. It notes that the Trump administration is piloting an AI program in six states to reduce unnecessary medical spending. The article also highlights that Medicare Advantage plans deny millions of full or partial claims under prior authorization, including requests for skilled nursing and rehabilitation admissions, citing June federal reports.