AI Systems Driving Record Denial Rates
The 2024 American Medical Association survey reveals alarming trends in prior authorization practices, with 61% of physicians concerned about health insurers’ increasing reliance on unregulated artificial intelligence systems. According to the February 24, 2025 AMA press release, these AI-driven authorization processes are operating with minimal human oversight, resulting in unprecedented denial rates for necessary medical care.
Physicians report that these automated systems are exacerbating patient harm and contributing to significant healthcare waste across the system. The trend represents a troubling shift away from human clinical judgment toward algorithmic decision-making in vital healthcare determinations.
Patient Safety Concerns Reach Critical Levels
The survey findings paint a disturbing picture of patient outcomes under current prior authorization requirements:
Serious Harm Documented:
More than 29% of physicians report that prior authorization processes have directly resulted in serious adverse events for their patients, including hospitalizations, permanent impairment, and even death.
Treatment Delays Widespread:
An overwhelming 93% of physicians indicate that prior authorization procedures consistently delay patients’ access to necessary care and treatments.
Deteriorating Clinical Outcomes:
Nearly all surveyed physicians (94%) observe that these authorization requirements negatively impact overall clinical outcomes for their patients.
Healthcare Delivery Disrupted by Authorization Barriers
The authorization burden extends beyond clinical outcomes to affect healthcare system efficiency and patient financial well-being:
Treatment Abandonment Rising:
82% of physicians report that patients frequently abandon prescribed treatments entirely due to authorization hurdles.
Financial Burden Shifted to Patients:
80% of physicians observe that their patients are increasingly forced to pay out-of-pocket for care when insurers deny coverage.
Physician Time Diverted:
Medical practices now spend approximately 13 hours weekly completing an average of 39 authorization requests, contributing significantly to administrative waste.
Burnout Crisis Intensifies Among Medical Professionals
The administrative toll of prior authorization contributes substantially to the ongoing healthcare workforce crisis:
Burnout Factor Identified:
Nearly 89% of physicians cite prior authorization requirements as a significant contributor to professional burnout.
Worsening Trends Despite Reform Promises:
75% of physicians report seeing increased authorization denials over the past five years, despite industry promises to streamline processes.
Insurance Giants Face Mounting Criticism
Major insurers have failed to deliver on promises to reduce authorization burdens:
Reform Promises Unfulfilled:
Though insurers like UnitedHealthcare and Cigna announced reductions in services requiring authorization in 2023, only 16% of physicians working with these payers have observed any actual reduction in workload.
UnitedHealthcare Particularly Burdensome:
72% of physicians rate UnitedHealthcare’s authorization requirements as “high” or “extremely high” burden.
AMA Calls for Augmented Intelligence Approach
The AMA is advocating for a fundamental shift in how AI is deployed in healthcare decision-making:
Human Oversight Essential:
“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,” states Bruce A. Scott, M.D., AMA president.
Augmented vs. Artificial Intelligence:
The AMA promotes an “augmented intelligence” approach that uses technology to support, rather than replace, human clinical judgment in authorization decisions.
As AI systems become increasingly embedded in healthcare administration, the survey findings highlight urgent implications for patient safety, healthcare quality, and system efficiency that require immediate attention from policymakers and industry leaders.
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