Medicare advantage becoming a disadvantage with use of artificial intelligence in prior authorization review
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.
Fields of Study & Subjects
Artificial Intelligence in Healthcare and Education
Medical Malpractice and Liability Issues
Electronic Health Records Systems
Publication details
- Journal / source
- npj Digital Medicine
- Publisher
- Springer Science and Business Media LLC
- Volume
- 9
- Issue
- 1
- Publication date
- 4 February 2026
- Language
- EN