Insurers use AI to automate processes similar to prior authorization, the place suppliers or sufferers should get insurer approval earlier than receiving particular medical providers, procedures, or medicines. The excessive denial charges from AI-driven automation have pissed off physicians, main them to counter by utilizing AI instruments themselves to draft appeals towards the denials.
Bronchial asthma medicine, new weight reduction medicine and biologics — a category of medicine that may be life-saving for folks with autoimmune illness and even most cancers — are routinely denied protection by insurance coverage corporations. Knowledge exhibits that clinicians hardly ever enchantment denials greater than as soon as, and a current American Medical Affiliation survey confirmed that 93% of physicians report care delays or disruptions related to prior authorizations.
“Normally, any costly drug requires a previous authorization, however denials are typically centered on locations the place the insurance coverage firm thinks {that a} cheaper different is on the market, even when it’s not nearly as good,” Dr. Ashish Kumar Jha, dean of the Faculty of Public Well being at Brown College, defined in an earlier interview with Computerworld.
