Denying the Denials: AI in Pre-Authorizations

The insurance side of AI

Centers for Medicare and Medicaid Services (CMS) does not require insurers to disclose how they make authorization decisions or how predictive technologies factor into the process. A 2025 survey found that most insurers are now using AI, with 68% using it for prior authorization reviews. The battle lines are drawn when decisions to deny care are made without human oversight. In this same survey, only 12% of insurers said they used or were considering using, AI specifically to deny prior authorizations. 

The provider pushback

Prior authorization is costly for providers, who spent an estimated $13 billion in 2023 on administration burden. New tools help healthcare providers complete tasks such as appealing denials. One example is Claimable, which collects patient and coverage information to generate and send appeal letters to insurers. 

Battle of the bots

For now, this landscape is shaping up like an arms race where insurance bots deny claims, only to be met with automatic appeals from the provider. Courts are beginning to weigh in as insurance giants face lawsuits from patients alleging AI-driven denials occurred without required human oversight.