Introduction
Health insurers are using artificial intelligence to deny care at a scale and speed no human reviewer could match. Federal investigations, class action lawsuits, and physician surveys all point to the same conclusion: payer-side AI is not supporting clinical decisions, it is replacing them. This paper examines how these systems work, who is accountable, and what providers must do now.
Key Takeaways
- Nearly 53 million prior authorization requests were filed with MA insurers in 2024
- 81.7% of appealed Medicare Advantage denials were fully or partially overturned
- UnitedHealth’s skilled nursing denial rate increased ninefold in four years
- Cigna denied 300,000 claims in two months at 1.2 seconds per case
- 94% of physicians say prior authorization harms patient clinical outcomes
- 29% of physicians reported a serious adverse event linked to prior authorization delays
- The U.S. still has no comprehensive federal regulatory framework for payer AI