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Hospitals urge oversight of AI in prior authorization after national denials spike
Summary
The Wyoming Hospital Association asked the committee to study use of artificial intelligence in insurance prior authorization and termination decisions after national examples showed high automatic denial rates overturned on human review.
Eric Boley of the Wyoming Hospital Association urged the joint committee to examine use of artificial intelligence by insurers for prior authorization and coverage termination decisions.
Boley pointed to national reporting about one insurer whose AI-driven prior-authorization system initially denied roughly half of requests and that more than 70% of those denials were later overturned on human review. "I don't think we have a huge problem here, but I think we can be, preemptive," he said, proposing that any AI use be coupled with human review by trained staff.
He asked the committee to include the topic in interim work as a complement to prior sessions' work on prior authorization and credentialing. Committee members did not take immediate action; hospital representatives asked for time to develop specific policy language or safeguards for the interim.
