If you or a loved one has ever needed a prescription or medical procedure, you may have faced a frustrating hurdle: prior authorization. This is the process where your doctor must get approval from your insurance company before the treatment can go ahead. It is meant to control costs and prevent unnecessary care, but it often leads to long delays and stress for patients.
Now, artificial intelligence is being used to handle these requests. The big question is whether AI will make this process smoother or create new problems. According to Joshua Cohen on LinkedIn, AI already plays a key role in prior authorization. The debate is whether it will improve things or make them worse.
How Prior Authorization Works Today
When used carefully, prior authorization can stop overuse of expensive treatments when cheaper options exist. But in practice, it often creates a heavy burden. Physicians say the process causes significant delays in care. Patients sometimes give up on their recommended treatments while waiting for their insurance company to confirm that the care is medically necessary.
This is where AI comes in. The idea is that AI can process these requests much faster than humans, potentially cutting down wait times and reducing the administrative workload on doctors and insurance staff.
The Promise and the Risk of AI
Supporters of AI in prior authorization argue that it can speed up approvals, reduce errors, and lower costs. An AI system can quickly check a patient's medical records against insurance guidelines and make a decision in seconds instead of days.
However, critics worry that AI could make things worse. If the AI system is not properly trained or if it uses biased data, it could deny legitimate requests more often than a human would. There is also the issue of transparency — patients and doctors may not understand why an AI denied a claim, and appealing that decision could be even harder.
"Will AI Fix Prior Authorization — or Make It Worse?" — Undark
What This Means for Patients
For patients, the stakes are high. Prior authorization already causes many to abandon treatments. If AI makes the process faster and more accurate, it could be a major improvement. But if AI introduces new errors or makes it harder to get care, it could deepen the existing problems.
The key will be how these AI systems are designed and regulated. Without proper oversight, AI could automate unfair denials at a scale that is impossible for humans to challenge.
Our Take: AI Is Not a Magic Fix
In our view, AI has real potential to improve prior authorization — but only if it is used carefully. The current system is broken, and technology can help. But we must not assume that AI will automatically make things better. The same biases and inefficiencies that exist in the human-run system can be coded into AI, sometimes in ways that are harder to detect.
Regulators, insurers, and tech companies need to work together to ensure that AI is transparent, fair, and accountable. Patients should have a clear way to appeal AI decisions. Without these safeguards, AI could turn a frustrating process into an impossible one.
The question is not just whether AI can fix prior authorization — it is whether we will let it do so responsibly.
