The American Medical Association has flagged what frontline physicians already feel: AI is being deployed faster on the denial side of healthcare than on the care side. Prior-authorization denials are rising, and increasingly the first “reviewer” of a surgeon’s request is a model optimised to find reasons to say no.
This is an asymmetry worth naming plainly. Payers have invested in automation that protects margin. Clinicians have largely not invested in automation that protects access. The result is a negotiation where one side argues at machine speed and the other argues at human speed, one fax at a time.
I am not arguing against utilization review. Some requests should be questioned. I am arguing that a denial generated by an algorithm deserves a response built with the same rigour we would demand of any clinical claim, with the evidence, the guideline citation, and the patient-specific reasoning assembled and structured rather than retyped from scratch on every appeal.
For a cardiac program running high-acuity cases, a wrongful denial is not a billing inconvenience. It is a delay to a procedure with a time-sensitive outcome. The defensible position is to treat the appeal pipeline as clinical infrastructure: capture the indication once, structure it well, and let the documentation work as hard for the patient as the payer’s model works against them.
The deeper point is governance. An automated system that denies care owes the patient and the physician transparency about what it weighed and a fast, accountable path to challenge it. Speed on the denial side without symmetry on the appeal side is not efficiency. It is rationing with a technical alibi.
Dr. Khalpey is chief medical AI officer at Atari AI, chair of applied clinical AI at the Atari AI Foundation and director of Khalpey AI Lab.
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