Can AI Fix the Medical Approval Process?

For many patients, getting a doctor’s recommendation is only the first step in a long and difficult journey. Before a medical procedure or a prescription medication can be covered, insurance companies often require a process called prior authorization. This is a check that ensures the treatment is medically necessary and that there are no cheaper alternatives. However, this system is frequently criticized for causing long delays, which can lead patients to give up on their health needs while waiting for an answer.

Following recent discussions about the role of technology in our lives, a new development has emerged in the healthcare sector. According to Ars Technica, the administration of President Donald Trump is currently testing a program in six states that uses artificial intelligence (AI) to manage these insurance requests. The goal of this pilot program is to reduce unnecessary medical spending. By using AI to quickly sort through large amounts of information, the government hopes to make the approval process faster and more efficient for everyone involved.

Despite the potential for speed, the use of AI in this area is controversial. Many doctors are worried about how these computer programs make decisions. A 2025 survey by the American Medical Association (AMA) found that 61 percent of physicians are concerned that AI will make it harder for patients to get the care they need. These doctors fear that the technology will lead to more wrongful denials of coverage, forcing patients to go through a long and tiring appeal process just to get the treatment their doctors already recommended.

There is a strong disagreement regarding how these tools should be used. Health policy analyst Camm Epstein, writing in an email to Undark, argued that the focus of AI should be clear. Epstein noted that “AI should be used to make appropriate care easier to approve, not necessary care easier to deny.” This view is shared by many in the medical community who believe that technology should support the relationship between doctors and patients, rather than acting as a barrier to health.

To address these concerns, the AMA is calling for more openness from insurance companies. They are advocating for a requirement that insurers provide detailed clinical reasoning whenever they deny a request. This means the companies would have to explain exactly why a treatment was rejected. The AMA also wants more transparency regarding AI algorithms—the sets of rules or instructions that computers use to solve problems—so that doctors can understand how these systems reach their conclusions.

This debate is part of a larger conversation about how we balance new technology with human needs. As noted in previous reports, AI has the potential to change many parts of our lives, from education to medicine. While the promise of faster approvals is attractive, the risk of losing the human touch in medical decisions remains a significant worry for many professionals. If an AI system denies coverage, it may be difficult for a patient to challenge a decision made by a machine that does not fully understand their specific medical history.

As the six-state pilot program continues, the results will be watched closely by both patients and healthcare providers. If the program succeeds, it could set a new standard for how insurance companies handle medical requests across the country. However, if the concerns of doctors prove to be correct, it may lead to a push for stricter regulations on how AI is used in the insurance industry. For now, the future of AI in healthcare remains a mix of hope for better efficiency and fear of losing access to vital medical services.