The American Society of Nuclear Cardiology (ASNC) and the American Medical Association (AMA) are opposing the increasing use of AI by insurers to automate prior authorization denials, citing negative impacts on patient care and physician burnout. At the AMA House of Delegates meeting, Resolution 226 was adopted, calling for federal oversight of AI-driven utilization review to address bias and improve transparency.
Dr. Suman Tandon of ASNC emphasized that AI-driven denials often ignore clinical nuances essential for patient-specific care. ASNC supports bipartisan legislation (H.R. 3514) requiring Medicare Advantage plans to report AI prior authorization statistics to CMS, including denial rates and impacts on vulnerable populations.
In 2023, of 15 million Medicare Advantage prior authorization requests, 3.2 million were denied, with 82% of appealed denials overturned—indicating many inappropriate rejections. Tandon warned that AI models lack the clinical judgment necessary for nuanced medical decisions, risking patient trust and care delays.
ASNC and medical societies urge AMA and Congress to ensure AI complements, not replaces, clinical expertise in prior authorization processes.
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