AI News Monitor

Physicians are raising alarms over health insurers’ increasing reliance on artificial intelligence to automatically deny coverage for radiology and other medical services, warning that the technology is exacerbating delays in patient care.

Recent reports from heart imaging specialists highlight cases where insurers denied coverage for cardiac PET scans—a key diagnostic tool—without medical justification, instead pushing for less comprehensive alternatives like coronary CT. In response, the American Society of Nuclear Cardiology (ASNC) sponsored a resolution at the American Medical Association’s (AMA) annual meeting, urging stricter oversight of A.I.-driven prior authorization systems.

“The use of A.I. is making the issue of prior authorization worse, not better,” said Dr. Suman Tandon, a cardiac imaging specialist at St. Francis Hospital in New York and ASNC’s representative to the AMA. “This issue is deeply concerning to physicians.”

Push for Regulation
Resolution 226, adopted in part by the AMA’s House of Delegates, calls for federal and state scrutiny—and potential legislation—to ensure A.I. tools used by insurers are transparent, unbiased, and medically sound. Testimony from physicians cited cases where automated denials led to “patient harm and distress,” including delays in prescription renewals and necessary imaging.

While some argued that existing AMA policies already address these concerns, the resolution reflects growing frustration over insurers’ expanding control over medical decisions.

Legislative Efforts Gain Momentum
Separately, medical societies are rallying behind the Improving Seniors’ Timely Access to Care Act, a bipartisan bill reintroduced in May to streamline prior authorization under Medicare Advantage. The American College of Radiology and other groups endorse the measure, which aims to reduce bureaucratic hurdles for patients.

“Patients and physicians—not insurance companies—should be at the center of treatment decisions,” said Dr. Howard Sandler, chair of the American Society for Radiation Oncology.

The AMA also passed a broader policy opposing insurers’ use of utilization management systems to restrict care, citing “rampant” industry consolidation that allows payers to unilaterally define medical necessity.

As A.I. tools proliferate in healthcare, physicians warn that without safeguards, insurers’ algorithms could further erode trust—and patient outcomes