You Just Got Denied Care – Did AI Make That Decision?

AI is everywhere.

It's helping us write emails.

Plan vacations.

Summarize meetings.

Make grocery lists.

Build workout plans.

In many ways, AI has made everyday life easier.

But there's one area it may be hurting us:

Health insurance decisions, and specifically, care approvals.

Why?

Because behind every medical decision is a real person.

A real family.

Real consequences.

So should an algorithm have a say in whether you receive care?

It's a question more people are asking as health insurance companies increasingly use AI to review prior authorization requests and other coverage decisions.

While technology can make administrative tasks faster, many doctors, researchers, and policymakers worry that efficiency may be coming at the expense of patient care.

Let's take a closer look at what's happening.

How is AI Being Used in Healthcare?

Artificial intelligence has the potential to improve healthcare in many ways.

It can help organize medical records, identify patterns in large amounts of data, support clinical research, and reduce administrative work for healthcare professionals.

Those are all promising developments.

The concern isn't that AI exists, or that it’s being used in healthcare.

It's how it's being used in healthcare.

Today, some health insurance companies are using AI as part of the prior authorization process – the process of reviewing whether certain tests, procedures, medications, or treatments will be covered.

In theory, AI can help speed up these reviews.

In practice, it’s contributing to inappropriate denials, delays in care, and more work for both patients and healthcare providers.

Why Are So Many Doctors Concerned?

The American Medical Association's (AMA) 2025 Prior Authorization Survey paints a concerning picture.

According to the survey:

AI-assisted reviews may deny care up to 16 times more often than traditional reviews.
94% of physicians say prior authorization delays necessary care.
82% of physicians say patients sometimes give up on treatment altogether because of prior authorization challenges.

Think about that for a moment.

People are getting denied care not because a treatment wasn't appropriate.

Not because a doctor changed their recommendation.

But because the process was outsourced to AI.

When someone is already worried about their health, navigating delays, paperwork, and appeals only adds more stress.

Healthcare Isn't Just Paperwork

When people hear the words prior authorization, it's easy to picture computer software, forms, and administrative processes.

But ideally, there should be a real person behind every request…

…because there’s a real patient.

A child who needs imaging.

A parent recovering from surgery.

A grandparent waiting for rehabilitation.

A family hoping to start treatment as soon as possible.

Healthcare decisions aren't just about paperwork.

They're about people's lives.

That's why many experts argue that AI should support healthcare professionals, not replace them when it comes to care reviews.

The authors of a recent npj Digital Medicine perspective call for greater transparency, stronger oversight, and more safeguards to ensure AI is used responsibly, especially when it comes to coverage decisions.

The Hidden Cost of Prior Authorization

Most people think of prior authorization as an inconvenience.

But physicians say the consequences can go much deeper.

According to the AMA survey, prior authorization doesn't just delay treatment, it contributes to physician burnout and takes valuable time away from patient care.

On average, physicians and their staff spend 13 hours every week completing prior authorization requests.

Nearly nine out of ten physicians say the process has increased burnout, and many say they simply don't have the time or resources to appeal denied requests.

That creates a ripple effect.

Doctors spend more time on paperwork.

Patients wait longer for answers.

Families are left wondering what happens next.

Healthcare works best when providers can focus on caring for people, not navigating unnecessary administrative hurdles.

Why Transparency Matters

One of the biggest concerns surrounding AI in healthcare isn't just that it's being used.

It's that patients often don't know when it's being used.

Researchers argue that health insurance companies should be more transparent about how AI tools influence coverage decisions, what information they're using, and what safeguards are in place to ensure you receive fair, individualized reviews.

If an algorithm helps decide whether your care is approved, shouldn't you know?

Healthcare decisions shouldn't feel like a black box.

The more transparent the process is, the easier it is for patients to understand their options and advocate for their care.

A Different Approach

At Knew Health, we believe technology should make healthcare simpler, not less human.

That's why every Medical Need is reviewed by a real person.

Every phone call is answered by a Care Team Member who listens, asks questions, and helps guide you through the process.

They might even already know your name and situation, so you don’t have to explain yourself from scratch every time you call.

When you're dealing with a health concern, the last thing you need is to wonder whether an algorithm is making decisions about your care.

You deserve to know there's someone on the other end who sees you as more than just a case number.

Frequently Asked Questions

Is AI really making healthcare decisions?

Some health insurance companies use AI to help review prior authorization requests and other coverage decisions. Many experts believe AI can improve efficiency, but at the risk of excessive care denials – with AI, care is getting denied up to 16x more often.

What is prior authorization?

Prior authorization is when a health insurance company reviews certain tests, procedures, or medications before agreeing to cover them. While it's intended to manage costs, many physicians say it can delay necessary care.

Why are doctors concerned about AI in healthcare?

Many physicians worry AI-assisted reviews may contribute to more denials, delayed treatment, and additional administrative work. Researchers have also called for greater transparency and safeguards to ensure AI is used responsibly.

Does Knew Health use AI to review Medical Needs?

No, we do not. Every Medical Need is reviewed by a real person. We believe healthcare decisions deserve thoughtful human review, because behind every Medical Need is a real person, not just a case number.

The Bottom Line

Artificial intelligence is changing healthcare, and it's likely to play an even bigger role in the years ahead.

Used thoughtfully, AI has the potential to reduce administrative work and improve efficiency.

But when it comes to decisions that affect people's health, many doctors, researchers, and policymakers agree that human review remains essential.

The goal isn't to minimize AI use where it could be helpful.

It's to make sure it's used responsibly, transparently, and in ways that support patients rather than creating new barriers to care.

At Knew Health, that's a principle we believe in.

Behind every Medical Need is a real person, a real family, and a real situation.

AI can be an effective, supportive tool, but your care deserves human review – someone who can understand the reality and nuance of what you're going through.

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