CHICAGO, Feb. 24, 2025 – A significant majority of physicians are expressing alarm over the increasing use of artificial intelligence (AI) by health insurance companies. A new survey from the American Medical Association (AMA) highlights concerns that this unregulated AI automation and predictive technology is undermining sound medical judgment and inappropriately denying patients the coverage necessary for vital medical care.
The AMA survey found that three in five physicians (61%) are worried that health plans’ use of AI is fueling a rise in prior authorization denials, which exacerbates avoidable patient harms and leads to unnecessary costs now and in the future. Prior authorization requirements, known for creating obstacles to timely, accessible, and affordable treatment, have long been a major problem in patient care.
Insurers have recently shifted to AI decision-making tools, which often produce prior authorization decisions with minimal or no human review. These tools have faced criticism for generating high rates of care denial – in some cases, denial rates are reported to be 16 times higher than is typical.
“Using AI-enabled tools to automatically deny more and more needed care is not the reform of prior authorization physicians and patients are calling for,” said AMA President Bruce A. Scott, M.D. “Emerging evidence shows that insurers use automated decision-making systems to create systematic batch denials with little or no human review, placing barriers between patients and necessary medical care. Medical decisions must be made by physicians and their patients without interference from unregulated and unsupervised AI technology.”
The AMA strongly advocates for AI to augment decision-making, referring to this approach as “augmented intelligence,” and not to supplant human involvement in patient care, coverage, or treatment.
An AMA’s Augmented Intelligence Research study released earlier this month found that nearly half of all physicians (49%) ranked oversight of payers’ use of AI in medical necessity determinations among the top three priorities for regulatory action. In line with these findings, newly adopted AMA policy identifies substantial concerns with insurer use of AI. Physicians have reported that delayed and disrupted care continue to be a predictable and frustrating aspect of the patient experience, as widespread utilization of prior authorization programs hinders the ability to deliver vital medical treatments. Such issues jeopardize quality care and result in patient harm.
Patient Harm: More than one in four physicians (29%) reported that prior authorization has led to a serious adverse event for a patient in their care, including hospitalization, permanent impairment, or death.
Poor Outcomes: More than nine in 10 physicians (94%) reported that prior authorization has a negative impact on patient clinical outcomes.
Delayed Care: More than nine in 10 physicians (93%) reported that prior authorization delays access to necessary care.
Disrupted Care: More than four in five physicians (82%) reported that patients abandon treatment due to authorization struggles with health insurers.
Shifted Costs: Four in five physicians (80%) reported that prior authorization delays or denials “at least sometimes” force patients to pay out-of-pocket for medications.
Lost Workforce Productivity: Over half of physicians (58%) who cared for patients in the workforce reported that prior authorizations have impeded a patient’s job performance.
The significant hurdles associated with the prior authorization process and the fight against denials amplify physician burnout, while diverting scarce resources away from essential patient care toward administrative tasks.
Added Burden: Physicians reported they complete an average of 39 prior authorizations per week, and nearly one in three physicians (31%) stated that prior authorization requests are often or always denied.
Physician Burnout: Nearly nine in 10 physicians (89%) reported that prior authorization somewhat or significantly increases physician burnout.
Denial Trend: Three-quarters of physicians (75%) reported the number of prior authorization denials has increased somewhat or significantly over the last five years.
Diverted Time and Resources: The workload to handle prior authorizations consumes 13 hours per week of physician and staff time, and two in five (40%) employ dedicated staff to handle tasks related to prior authorization.
Beyond the negative effect on patient care, the survey also revealed that prior authorization creates significant waste and unnecessary costs across the health system.
Wasted Health Resources: More than four in five physicians (88%) reported that prior authorization requirements lead to higher overall utilization of health care resources, resulting in unnecessary waste rather than cost savings. More specifically, physicians reported resources were diverted to ineffective initial treatments (77%), additional office visits (73%), urgent or emergency care (47%), and hospitalizations (33%) due to prior authorization requirements.
Despite growing evidence that prior authorizations for drugs and medical services pose a threat and substantial burden to patient-centered care, the AMA survey revealed that the health insurance industry has shown little follow-through on five key reforms that were mutually agreed to by the AMA, pharmacists, medical groups, hospitals, and health insurers in January 2018.
While UnitedHealthcare (UHC) and Cigna announced reductions in the number of services that require prior authorization in 2023, only 16% of physicians who work with UHC and 16% of physicians who work with Cigna reported that these changes have reduced the number of prior authorizations completed for these plans. In addition, physicians reported consistently high administrative burdens across all major health insurers when complying with prior authorization requirements. Among health insurers, UHC was ranked as the most burdensome regarding prior authorizations, with 72% of physicians giving UHC a “high” or “extremely high” burden rating. Humana (64%), Anthem/Elevance (59%), Aetna (57%), Cigna (55%), and Blue Cross Blue Shield (54%) followed closely with high burden ratings for prior authorization.
The AMA is actively working to improve prior authorization programs so that physicians can focus on managing patient care rather than administrative burdens.
Patients, physicians, and employers can learn more about reform efforts and share personal experiences with prior authorization at FixPriorAuth.org.
