AI prior authorization denials threaten patient care

The 2024 American Medical Association prior authorization physician survey reveals that 61% of physicians are alarmed by the health insurance industry’s increasing reliance on unregulated artificial intelligence in prior authorization decisions. As mentioned in a Feb. 24, 2025, AMA press release, the survey highlights that AI-driven systems with little or no human review are substantially driving up denials of necessary care, exacerbating patient harm and contributing to widespread healthcare waste.

Physicians have long decried the burdensome nature of prior authorization requirements, which hinder timely access to evidence-based treatments. The survey findings underscore several critical issues:

• Patient harm. More than 29% of physicians reported that prior authorization has led to serious adverse events, including hospitalization, permanent impairment or death.
• Delayed care. Over 93% of respondents indicated that these processes delay access to critical treatments.
• Poor outcomes. A striking 94% noted that prior authorization negatively impacts patient clinical outcomes.
• Disrupted care and increased costs. With 82% of physicians reporting that patients abandon treatment due to authorization hurdles and 80% observing that patients are forced to pay out-of-pocket, the system is clearly strained.
• Physician burnout. Nearly 89% stated that prior authorization practices contribute significantly to burnout, with an average of 39 authorizations completed per week consuming roughly 13 hours of physician and staff time.

The survey also reveals that 75% of physicians have seen an increase in prior authorization denials over the past five years. Despite reform agreements reached in 2018 involving key stakeholders, the introduction of AI has intensified these challenges.

"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," Bruce A. Scott, M.D., AMA president said in the AMA press release. "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 report also notes that while insurers like UnitedHealthcare and Cigna announced reductions in the number of services requiring prior authorization in 2023, only 16% of physicians working with these payers have observed any reduction in their workload. UnitedHealthcare, in particular, received a "high" or "extremely high" burden rating from 72% of physicians.

As the debate over AI's role in healthcare intensifies, the AMA advocates for a shift toward "augmented intelligence," using AI to support, not replace, human decision-making. The survey's findings signal urgent implications for patient safety and the overall efficiency of the healthcare system.

Alivia Kaylor is a scientist and the senior site editor of Pharma Life Sciences.