Artificial intelligence is increasingly being deployed to manage "prior authorisation," the process by which health insurers pre-approve medical treatments, but experts are divided over whether it will ease or worsen a system already widely criticised by patients and doctors. While AI could theoretically speed up approvals for clearly valid claims and reduce harmful delays, critics warn it may instead be used to automate and increase wrongful denials of necessary care, prompting calls for greater transparency and accountability from insurers.

A 2025 American Medical Association survey found 61% of doctors feared AI would worsen denials of treatments they considered necessary, with the AMA pushing for insurers to give detailed clinical justifications and disclose more about their algorithms. In Medicare Advantage, which covers roughly 55% of eligible seniors and disabled Americans, insurers issue millions of denials annually, and a June government report found some plans even reject requests for skilled nursing and rehabilitation care. A Commonwealth Fund survey found around one in five privately insured working-age adults reported a denial affecting themselves or a family member in 2025, with 41% saying it delayed care and over a quarter saying their condition worsened as a result. The Trump administration is piloting an AI-driven cost-reduction programme in six states, while a 2024 Biden-era rule set new turnaround limits, requiring decisions within 72 hours for urgent requests and seven days for non-urgent ones.