Insurers are using AI to automate processes such as pre-authorization, where providers or patients must obtain approval from the insurer before receiving specific medical services, procedures or medications. High refusal rates linked to AI-based automation have frustrated doctors, leading them to counter by using AI tools themselves to write calls against denials.
Asthma medications, new weight-loss drugs, and biologics – a class of medications that can save the lives of people with autoimmune disease or even cancer – are routinely denied coverage by governments. insurance companies. Data show that clinicians rarely appeal denials more than once, and a recent American Medical Association survey showed that 93% of physicians report delays or disruptions in care related to prior authorizations.
“Usually any expensive drug requires prior authorization, but denials tend to focus on places where the insurance company thinks a cheaper alternative is available, even if it’s not as good,” Dr. Ashish Kumar Jha, dean of the school. of Public Health from Brown University, explained in an earlier interview with IT world.