Dr. Jesse Ehrenfeld criticized the prior authorization process in the healthcare system, emphasizing its role in delaying patient care and eroding trust. In an interview, he highlighted that patients often wait longer for insurance approval than for surgery scheduling. Despite proposed reforms by CMS to improve transparency and service standards, issues in the commercial insurance market persist. Ehrenfeld expressed concerns about the rise of AI tools in this space, noting a counterproductive cycle where technology used to deny care battles against other technology designed to facilitate access.
I hear about the frustration. I hear about the challenges of getting the third party payers to do what they're supposed to do, which is to cover services. All [prior authorization] does is just add delay and confusion. We have survey data year after year after year that shows patients give up - patients don't get what they need. It is an overused, burdensome tool that is frustrating for everybody.
There are dozens of companies that are building AI tools to deal with this process and to fight these denials. And we know, based on reports in the media, that third party payers are using automated tools to deny care. So we've got the bots beating the bots - which is not the best use of anybody's time or effort, to build technologies that are fighting each other when we could just reform the process.
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