Will AI fix prior authorization—or make it worse?
The government is piloting a program that uses AI for insurance-coverage decisions.
The government is piloting a program that uses AI for insurance-coverage decisions.
The short version
- If you’re like me, you or a loved one has struggled through the process of gaining pre-approval for the medical care that your physician has recommended.
- Personal stories abound regarding the tribulations of patients as they go through hoops to get their health insurer to pay for certain prescription medications, medical procedures, and more.
- The AMA advocates requiring insurers to provide detailed clinical reasoning to justify denials of coverage, in addition to more transparency regarding AI algorithms.
What happened
But it remains to be seen whether this new approach will help fix a tortuous system. Patients can request medical exemptions or appeal plan decisions, but the process is often complicated and cumbersome.
Why it matters
Forty-one percent of people who experienced a prior authorization denial said it delayed their care, and more than a quarter reported that their health problem worsened as a result.
Summary by Nerd News Network. Read the full article at Ars Technica via the links above and below.