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The Utilization of AI for Prior Authorization: Pros, Cons, and Consumer Perspectives

By: Leah Turner

In the ever-evolving world of healthcare, prior authorizations have long been a cumbersome process, burdening both insurers and healthcare providers. Recent developments in artificial intelligence (AI) are disrupting this process, offering the promise of efficiency and cost reduction. In this blog post, we’ll delve into general feelings about AI for prior authorizations, assess the pros and cons of this approach, and consider how consumers feel about the increasing role of AI in their healthcare.

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Recently, the American Medical Association (AMA) published an article advocating for greater regulatory oversight of the utilization of AI for patient claims and prior authorization review. The AMA also reported that one-third of physicians surveyed in their 2022 Prior Authorization Survey reported that prior authorization requirements have led to an adverse event for a patient in their care. While many see the use of AI as a positive step toward reducing administrative burden, it is not anticipated to be a magic wand that solves the larger issues at hand.

Consumer Perspectives on AI in Healthcare

In our recent Medicare Digital Tools Study, we looked into how seniors are utilizing technology and broadly at their understanding and perceptions of AI. Most seniors believe digital technology has positive societal impacts overall, but many also express having trouble with the pace of technological change.​

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Consumers’ feelings about the increasing use of AI in healthcare are a crucial aspect of this discussion. While some individuals welcome the potential for faster, more accurate, and cost-effective healthcare processes, others have concerns:

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While most seniors are aware of AI chatbots like ChatGPT and Bing Chat, a vast majority are not familiar with how they work and what they can be used for.

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The utilization of AI for prior authorizations holds some promise in terms of efficiency and cost savings. However, it also poses challenges, from initial investments to concerns about data privacy and bias. Equally as important, consumers’ perspectives are diverse, with trust, transparency, and human interaction playing central roles in their perceptions.

As the healthcare industry continues to harness the power of AI, it is essential for insurers and healthcare providers to address these concerns and maintain a patient-centric approach. Striking the right balance between AI-driven efficiency and maintaining the human touch in healthcare will be key. Only time will tell if the future of healthcare administration will be AI-enhanced, where technology and human care coexist harmoniously to provide the best possible outcomes for patients.

Want more in-depth information on this topic? Check out our related 2023 Medicare Digital Tools Study.