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When Algorithms Override Doctors: Time to Rethink AI in Healthcare
Ensuring Clinicians Stay in Control—Even in an AI-Driven System
Div Khetia
April 21, 2025
What You’ll Learn in This Issue:
What’s really happening with AI and prior authorizations—and why it matters
Stats from the AMA’s latest report that show just how bad it’s getting
The double-edged sword of automation: where insurers are using AI to deny, and how pharma can use it to defend
Practical ways pharma teams can counteract AI with AI to boost access and approval rates
Help physicians stay in control of patient care in an AI driven system
The Problem: When AI Denies the Doctor
Artificial intelligence was supposed to reduce friction in healthcare—not make it worse.
But according to a new AMA article, we’re seeing a disturbing trend: insurers are using AI not to support care decisions—but to deny them.
Here are the numbers that should make every pharma leader pause:
61% of physicians say AI-driven tools are leading to more prior authorization denials.
92% report that prior auth delays access to care.
82% say patients have abandoned treatment altogether because of the barriers.
A 2024 U.S. Senate investigation uncovered that some AI tools have denial rates 16x higher than typical review processes.
The issue? These aren’t just routine checks. Insurers are using AI to batch-deny claims, often with no human in the loop. That means care can be an in many cases is being blocked by algorithms—and not managed by physicians.
The Flip Side: Is AI All Bad?
To be fair, insurers argue that AI improves efficiency. It helps process the massive volume of prior auth requests and reduces staffing burdens. And yes, not every use of automation is harmful. But the lack of transparency, accountability, and explainability in these systems is causing a fundamental breakdown in trust.
When an AI denies a life-saving treatment based on a coded rule set—without any clinical nuance—it’s not just a glitch. It’s a systemic issue.
Pharma’s Opportunity: Fight AI With AI (Strategically)
So how can pharma respond?
By doing what the best teams already do: think beyond the pill. And in this case, think beyond the prior auth form.Below are specific ways pharma organizations can respond:
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