Medicare advantage becoming a disadvantage with use of artificial intelligence in prior authorization review.
editorial · Level V
Where this comes from
- Record sourced from PubMed, PMID 41639200.
- Also identified by DOI 10.1038/s41746-026-02387-x and PMC identifier 12979811.
- Licence recorded as CC BY-NC-ND.
- Because redistribution is not established, this page shows the abstract only. Follow the links below for the full text.
Abstract
Reported instances of AI-assisted, blanket denials of coverage have increased in recent years, particularly for Medicare Advantage plans, resulting in insurers facing criticism, class action lawsuits, investigations from Congress, and key providers leaving their networks. To ensure a fair healthcare system, action is needed to improve transparency in how AI tools approve or deny claims, and address provider burnout and patient burden due to navigating prior authorization requests and appeals.