At his rehabilitation medicine practice in Illinois, Dr. Azlan Tariq typically spent seven hours a week fighting with insurance companies reluctant to pay for his patients’ treatments. He often lost these battles.
There was a 45-year-old man who spent five months in a wheelchair while his insurer repeatedly denied appeals for a prosthetic leg. There was also a stroke survivor who was rehospitalized following a fall after his insurer determined that his rehabilitation could be done at home. Over the course of Dr.
Tariq’s 12-year career, these stories had become more common. The list of treatments that needed pre-approval from insurers seemed to be ever broadening, and the denials seemed ever rising. To spare his patients what he deemed subpar care and to reduce his own administrative burdens, Dr.
Tariq recently turned to an unlikely tool: generative AI. For a growing number of doctors, AI chatbots — which can draft letters to insurers in seconds — are opening up a new front in the battle to approve costly claims. These chatbots are accomplishing in minutes what years of advocacy and attempts at health care reform have not.
“We haven’t had legislative tools or policymaking tools or anything to fight back,” Dr. Tariq said.
Doctors streamline insurance fights
“This is finally a tool I can use to fight back.”
Physicians are increasingly using this technology to synthesize research and strengthen their appeals, hoping to reverse insurer decisions more effectively. In cases where meticulous documentation and numerous appeals were previously required, AI now provides a powerful, time-saving solution. Doctors and their staff spend an average of 12 hours a week submitting prior-authorization requests, a process widely considered burdensome and detrimental to patient health among physicians surveyed by the American Medical Association.
With the help of ChatGPT, doctors can now type in a couple of sentences, describing the purpose of the letter and the types of scientific studies they want referenced, and a draft is produced in seconds. Dr. Tariq said Doximity GPT, a version of the chatbot compliant with federal law restricting release of medical information, had halved the time he spent on prior authorizations.
More significantly, he said, the tool — which draws from his patients’ medical records and the insurer’s coverage requirements — has made his letters more successful. Since using AI to draft prior-authorization requests, he said about 90% of his requests for coverage had been approved by insurers, compared with about 10% before. While AI is still primarily used by individual, tech-savvy doctors, a growing number of companies are trying to bring the technology into the mainstream.
Several major health systems are piloting Doximity GPT, created to help with a number of administrative tasks including prior authorizations. But the insurance companies aren’t sitting still, either. Chris Bond, a spokesperson for America’s Health Insurance Plans, said insurers welcomed attempts to streamline the process, including those involving the appropriate use of AI.
As healthcare continues to evolve, the integration of technology, both by insurers and providers, highlights the importance of finding a balance. Ensuring that patients receive necessary care while maintaining a sustainable healthcare system remains the ultimate goal.
